Organ transplants in HIV disease

January 2003     View PDF     En español

As people with HIV are living longer due to advances in HIV medicines, there is a rise in death rates from conditions not historically associated with HIV. This includes an increase in risks and rates of both liver and kidney failure, often caused by hepatitis B or C, and underlying kidney disease or HIV-related harm to the kidneys (called HIV-associated nephrotoxicity, or HIVAN).

Anti-HIV therapies that are processed through the liver or kidney can also, in some cases, worsen these conditions. There have been some instances where the damage to the organ has been wholly caused by the side effects of therapies to treat HIV. For people with very advanced liver disease, liver transplantation is often the only option. People with kidney disease have slightly greater options, including dialysis, which involves being hooked up periodically to a machine to circulate and cleanse the blood.

It is critical to assess the effectiveness of organ trans­plantation in people with HIV in order to determine if it prolongs life, improves quality of life and if so then costs should be covered by third party payers (insur­ance, Medicaid/MediCal, etc.). The answers to these questions are not obvious since the kind of surgery associated with organ transplants can be very hard on anyone, let alone people suffering from HIV disease.