Kidney News August 2011 3#8 : Page 4
4 | ASN Kidney News | August 2011 Prevention of HIV Continued from page 1 Editorial Staff Editor-in-Chief: Pascale H. Lane, MD, FASN Managing Editor: Dawn McCoy Design: Lisa Cain Pennsylvania School of Medicine’s Scott Halpern, MD, PhD. “However, this ex-tremely rare event provides both an op-portunity for clinicians and transplant programs to revisit their practices and a useful reminder for clinicians and the public alike that no form of organ trans-plantation can ever be risk-free.” Halp-ern has published numerous articles on ethical issues related to transplantation. Editorial Board: Matthew D. Breyer, MD, FASN, Eli Lilly and Company Wendy Weinstock Brown, MD, Jesse Brown VA Medical Center, Northwestern University Feinberg School of Medicine, University of Illinois at Chicago Teri Browne, PhD, MSW, University of South Carolina Stephen Darrow, MD (fellow), University of Minnesota Medical Center Ira Davis, MD, Baxter Healthcare Corp. Caroline Jennette, MSW, University of North Carolina Kidney Center Richard Lafayette, MD, Stanford University Medical Center Edgar V. Lerma, MD, FASN, University of Illinois – Chicago /Associates in Nephrology, SC Teri J. Mauch, MD, FASN, University of Utah Victoria F. Norwood, MD, FASN, University of Virginia Sheila M. O’Day, MSN, University of Nebraska Medical Center Matthew A. Sparks, MD (fellow), Duke University Hospital Titte R. Srinivas, MD, Cleveland Clinic Public investigation Th e public health investigation was ini-tiated after the test results for both the recipient and the donor were positive for HIV approximately one year after the transplant. During the investigation, the donor and recipient, as well as the recip-ient’s transplant coordinator, nephrolo-gist, and HIV physician, and the donor’s primary care physician and transplant nephrologist, were interviewed. Medi-cal records were also reviewed. Th e do-nor reported unprotected sex with one male partner during the year before the transplant, including the time between his initial evaluation and organ recovery. HIV nucleic acid testing on donor leukocytes collected 57 days before the transplant yielded negative results; how-ever, DNA sequences for three HIV genes (envelope gp41, polymerase, and As offi cials work to prevent trans-plantation of organs infected with HIV, they question whether it should be legal to transplant organs from donors who test positive for the virus to others who test positive. Unlike in the late 1980s, now many individuals infected with HIV are living long lives and are developing conditions such as kidney disease. Also in contrast to the beginning of the AIDS epidemic, today’s infected indi-viduals are considered healthy enough to receive transplants. Because transplant wait lists are so long, some experts are calling for a repeal of the Nation-al Organ Transplant Act, which was passed more than two dec-ades ago and bans transplants from HIV-positive donors to HIV-positive recipients. Others are concerned about the ethical implications of making such a change though. Because HIV-positive recipients now have comparable outcomes following transplantation to HIV-negative recipients, “suggesting that HIV-positive recipients should get potentially substandard organs from HIV-positive donors is tan-tamount to suggesting that HIV-infected patients do not merit equitable access to higher-qual-ity organs,” said the University group-specifi c antigen p17) were detect-ed from donor leukocytes collected 11 days before the transplant. Recipient se-rum collected 11 days before the trans-plant was nonreactive for HIV-1 RNA by Aptima (Gen-Probe), but serum col-lected 12 days after the transplant was reactive. HIV DNA sequences from donor and recipient peripheral blood lym-phocytes collected on day 404 were ana-lyzed together with HIV DNA obtained from the donor’s frozen leukocyte speci-men collected 11 days before the trans-plant. Th e gp41, polymerase, and p17 sequences from the donor and recipient were nearly identical, suggesting that the two viruses are highly related. When to screen In this particular case, the donor was screened by enzymeimmunoassay 10 weeks before organ procurement but was not rescreened closer to the date of transplant surgery. According to the CDC, because individuals may acquire infections after such an initial evalu-ation, repeat testing is needed before organs are recovered from living do-nors. Transplant centers should screen liv-ing donors for HIV as close to the time of organ recovery and transplantation as possible, but no longer than seven days before organ donation, using sensitive tests (such as serology and nucleic acid testing) for both chronic and acute in-of Pennsylvania School of Medi-cine’s Scott Halpern, MD, PhD. “I see no clear reason for drawing this dichotomy when similar re-strictions are not placed on the donors from whom patients with hepatitis C may receive organs.” Halpern participated in an expert panel that oversaw the development of a new guideline, soon be issued by the Centers for Disease Control and Preven-tion (CDC), that includes recom-mendations on research into the risks and benefi ts of the use of organs from HIV-positive donors. The guideline also high-lights new measures to prevent unexpected transmissions of infectious diseases from do-nors to recipients. “The draft Public Health Service Guideline for Reducing Transmission of HIV, HBV, and HCV through Solid Organ Transplantation currently is in Health and Human Serv-ices clearance,” said Matthew Kuehnert, MD, the director of the CDC’s Offi ce of Blood, Or-gan and Other Tissue Safety. It is being published to replace the 1994 guideline and is be-ing issued to improve transplant patient safety and outcomes through recommendations to or-gan procurement organizations and transplant centers, Kuehn-ert said. Advertising Sales : Scherago International, Inc. 525 Washington Blvd., Suite 3310 Jersey City, NJ 07310 201-653-4777 phone 201-653-5705 fax mminakowski@scherago.com ASN Council: President: Joseph V. Bonventre, MD, PhD, FASN President-elect: Ronald J. Falk, MD, FASN Past-President: Sharon Anderson, MD, FASN Secretary-Treasurer: Donald E. Wesson, MD Publications Committee Chair: Sharon M. Moe, MD, FASN Councilors: Bruce A. Molitoris, MD, FASN, Sharon M. Moe, MD, FASN, Jonathan Himmelfarb, MD, FASN, Raymond C. Harris MD, FASN Executive Director: Tod Ibrahim Publications Manager: Robert Henkel ASN Kidney News is published by the American Society of Nephrology 1510 H Street NW, Suite 800, Washington, DC 20005. Phone: 202-659-0599 www.asn-online.org ASN Kidney News is the authoritative source for analysis of trends in medicine, industry, and policy aff ecting all practitioners in nephrology. Th e statements and opinions expressed in ASN Kidney News are solely those of the authors and not of the American Society of Nephrology (ASN) or the editorial policy of the editors. Th e appearance of advertisements in ASN Kidney News is not a warranty, endorsement, or approval of the products or services advertised or of their eff ectiveness, quality, or safety. Th e American Society of Nephrology disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Th e American Society of Nephrology is organized and operated exclusively for scientifi c and educational purposes, including enhancing the fi eld of nephrology by advancing the scientifi c knowledge and clinical practice of that discipline through stimulation of basic and clinical investigation, providing access to new knowledge through the publication of journals and the holding of scientifi c meetings, advocating for the development of national health policies to improve the quality of care for renal patients, cooperating with other national and international societies and organizations involved in the fi eld of nephrology, and using other means as directed by the Council of the Society. 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