The Advocate July/Aug 2022
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First Heart Transplant Performed Between HIV-Positive Donor, Recipient

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A hospital in New York City has performed the first heart transplant in which the donor and recipient were both HIV-positive.

Montefiore Health System in the Bronx performed the operation in the early spring of this year, the hospital announced in a news release last week. The recipient was a woman in her 60s who suffered from advanced heart failure. She received a kidney transplant at the same time as the heart transplant, spent five weeks in the hospital afterward, and is now seeing her transplant physicians for monitoring. There was no information disclosed about the donor.

“Thanks to significant medical advances, people living with HIV are able to control the disease so well that they can now save the lives of other people living with this condition. This surgery is a milestone in the history of organ donation and offers new hope to people who once had nowhere to turn,” Ulrich P. Jorde, MD, a top doctor at Montefiore and professor of medicine at Albert Einstein College of Medicine, said in the release.

The HIV Organ Policy Equity Act, a federal law adopted in 2013, enabled people living with HIV to donate their organs to an HIV-positive recipient, but it took nearly a decade for the first positive-to-positive heart transplant to be performed.

There are between 60,000 and 100,000 U.S. residents who could benefit from a new heart, but only about 3,800 transplants were performed in 2021, Montefiore officials said.

“This was a complicated case and a true multidisciplinary effort by cardiology, surgery, nephrology, infectious disease, critical care and immunology,” said the patient’s cardiologist, Omar Saeed, MD, who is also an assistant professor of medicine at Einstein. “Making this option available to people living with HIV expands the pool of donors and means more people, with or without HIV, will have quicker access to a lifesaving organ. To say we are proud of what this means for our patients and the medical community at large is an understatement.”

In another advance relating to HIV, physicians announced last week at the International AIDS Conference in Montreal that a 66-year-old man who had been living with HIV since 1988 was now free of both the virus and blood cancer. He had received a stem cell transplant from a donor with a rare genetic mutation that confers resistance to HIV, said doctors at City of Hope in Duarte, Calif. He is at least the fourth patient to go into long-term remission from HIV and the oldest, his doctors said. (Some sources say he is the fifth.) He was 63 when he received the transplant.

“We were thrilled to let him know that his HIV is in remission, and he no longer needs to take antiretroviral therapy that he had been on for over 30 years,” Jana K. Dickter, MD, a City of Hope physician, said in a press release. “He saw many of his friends die from AIDS in the early days of the disease and faced so much stigma when he was diagnosed with HIV in 1988. But now he can celebrate this medical milestone.”

“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,” the patient, who declined to be named, said in a statement shared by City of Hope. “I never thought I would live to see the day that I no longer have HIV.”

The procedure he underwent is complicated and risky, so it is not viable for most people living with HIV, doctors said. Such a transplant is recommended only for people who have both HIV and a form of cancer that could be treated with the transplant. However, it does indicate the great advances made in treatment of the virus.

The first person known to have achieved what was called a “functional cure” of HIV was Timothy Ray Brown, who received a stem cell transplant in 2007 in Berlin and was able to achieve an undetectable level of the virus without continuing to take antiretroviral drugs. Brown died in 2020 of leukemia unrelated to HIV.

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Tags: Health, HIV

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