HIV update - 18th February 2015

Kidney transplants from HIV-positive donors work well

South African doctors have reported that they have been able to successfully give people living with HIV transplants of kidneys donated by people with HIV who had just passed away.

The kidney is an organ that performs vital tasks related to the filtering of blood and the elimination of waste from the body. Although most people have two kidneys, having one healthy kidney is enough to ensure that you remain well. There is one kidney on each side of the body, around the middle of the back, just below the ribcage.

The two most important causes of kidney disease are diabetes and high blood pressure – both conditions which often affect people living with HIV but which can be successfully prevented or treated. Untreated HIV can cause kidney disease and some treatments used by people with HIV have also been associated with kidney problems.

In 2010, American doctors demonstrated that people living with HIV who are doing well on antiretroviral therapy can have good outcomes and survival rates after a kidney transplant. In that case, none of the donors had HIV.

Doctors were worried that transplanting a kidney from a person who had HIV might be too risky. In particular, could a drug-resistant strain of HIV be transmitted from the donor to the person receiving the kidney?

But there is a shortage of kidney donors. Especially in a country like South Africa, only accepting kidneys from HIV-negative people further limits the supply.

The doctors report on 27 HIV-positive people who received a kidney from an HIV-positive person who had died. The health of the donors was carefully checked. Concerning the people who received the kidneys, while they had end-stage kidney disease they all had an undetectable HIV viral load.

The number of people surviving was similar to that seen in other kidney transplant patients in the country. Three years later 84% were still alive and five years later 75% were.

However, there were eight cases of kidney rejection. This means that the immune system attacks the donated kidney because it recognises it as foreign tissue. In six of these cases, extra drugs which suppress the immune system successfully dealt with this problem.

But one concern with transplants for people living with HIV is this need to use drugs which suppress the immune system. (Left untreated, HIV also weakens the immune system.) The results were reassuring: while the patients’ CD4 counts dropped around 100 cells/mm³ during the first year after transplant, they rose after that. And all maintained an undetectable viral load, showing no signs of having acquired drug resistance.

To learn more about HIV and the kidneys, read NAM’s factsheet on the kidneys or an article from HIV Treatment Update published in 2010.

Poor results in African countries

People living with HIV in countries of sub-Saharan Africa are still being diagnosed late and are starting treatment late. There has been no improvement over the past decade, a new analysis has found.

People who start treatment late (with a CD4 count below 350) are much more likely to become ill or die than people who start treatment in good time.

Between 2002 and 2012, there was barely any change in the average CD4 count at diagnosis – from 250 to 309 cells/mm³. Similarly, the average CD4 count when starting treatment was 152 cells/mm³ in 2002 and 140 cells/mm³ in 2012. This means that people in African countries are less likely to be able to fully benefit from HIV treatment.