First Large-Scale Trial of Kidney Transplant Between HIV+ Donor and Recipient

President Obama’s signing of the HIV Organ Policy Equity (HOPE) Act into law 5 years ago finally made it legal for HIV-positive individuals to donate organs to HIV-positive recipients.

Now, the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health (NIH), is beginning the country’s first large-scale clinical trial that will monitor the recipients of kidneys from HIV-positive donors to determine if there are any complications during and after surgery.

“Organ transplants between donors and recipients with HIV have been going on in other countries,” Anthony Fauci, MD, director of the NIAID, told Contagion^®. South Africa has allowed HIV-positive-to-HIV-positive organ donations since 2008, for example. “The Hope Act is good not only for HIV-infected individuals, but it also decompresses a bit the burden and the stress [on uninfected people] who need kidneys.” In other words, if HIV-positive individuals can now receive kidneys from HIV-positive donors, this frees up kidneys from uninfected donors for use in uninfected recipients—a win-win for everybody, as it’s illegal to transplant organs from individuals with HIV into those who don’t have the virus.

As of earlier this year, there had been roughly 30 transplants from HIV-positive kidney donors to HIV-positive recipients performed in the United States. The new clinical trials, named the HOPE in Action Multicenter Kidney Study, will look at the results of 160 kidney transplants at various locations. Eighty recipients will get kidneys from donors who had been living with HIV, and 80 will serve as the control group, receiving kidneys from donors who are not infected with the virus. All of the donors will be deceased, and their HIV status will not be masked to either the patients or the research teams.

The kidney recipients’ physical and emotional states will be closely watched throughout the process. Some of the potential problems that may spring up include organ rejection or failure as well as failure of HIV medications that had previously been working. The team will also be on the lookout for any other problems that may arise as a result of introducing an organ infected with a particular strain of HIV into the body of a person who may be infected with a different strain of HIV, such as HIV superinfection, in which a person contracts more than 1 strain of the virus. “Does one person’s virus impact another person’s infection?” Dr. Fauci asked, highlighting one of the trial’s central questions. “The trial is trying to determine whether this is both safe and whether there are other unintended consequences.”

This past January, 3 medical centers in the United States were approved to perform kidney transplants between living HIV-positive donors and HIV-positive recipients. In reporting on that development, Contagion ^® interviewed Dorry Segev, MD, PhD, professor of surgery at the Johns Hopkins School of Medicine and a transplant surgeon, who indicated that he felt it was likely physicians would be able to control with drugs any new strain of HIV introduced into a recipient’s body the same way they are able to control the recipient’s own strain of HIV. Further research, he explained, would help scientists understand how 1 strain of HIV could become dominant.

For HIV-positive patients with end-stage renal disease, the prospect of receiving a kidney from an HIV-infected donor will likely be a very welcome one, considering the alternative: potentially waiting for years on a transplant list and receiving dialysis multiple times per week. Almost 96,000 individuals in this country die each year waiting for a new kidney.

Ms. Saloman is a health writer with more than 20 years of experience working for both consumer- and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.