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Surgeons at Johns Hopkins Hospital have transplanted the kidney of an HIV-positive living donor to an HIV-positive recipient, a medical breakthrough that, he hopes, will expand the blood supply reserve. available organs and to change the perception of HIV.
The donor, Nina Martinez, aged 35, and the recipient, who chose to remain anonymous, are recovering at the hospital after Monday's surgery, doctors said. The recipient no longer needs kidney dialysis for the first time in a year.
The procedure is another step in the evolution of HIV – considered a certain death when the AIDS epidemic began in 1981 – and a step forward for the 1.1 million people carrying the virus. The drugs used today can suppress the infection at undetectable levels in many people, and President Trump recently promised to end its transmission to the United States by 2030. But the stigma persists.
"Society perceives me, and people like me, as people who bring death," Martinez said in an interview Saturday before the operation. "And I can not find a better way to show that people like me can bring life."
Martinez, who contracted HIV after receiving a blood transfusion, appeared at a press conference at Hopkins on Thursday to announce the operation, the first of its kind. She said that she was feeling good and that she was eager to train for the October marathon of the Marine Corps in Washington.
"HIV-positive people today can not donate blood, but they can now donate a kidney," said Dorry Segev, professor of surgery at the Johns University School of Medicine. Hopkins, who led the research team and removed Martinez's left kidney. . "They have an illness that, 30 years ago, was a death sentence.Today, they are in such good health that they can give life to someone who dies. other."
Surgeons have transplanted 116 organs of deceased HIV-positive donors into HIV-infected recipients since 2016, when a new law authorizing this intervention came into force. Among the non-seropositive individuals, more than 152,000 living donor kidneys have been transplanted in the last 30 years and a few hundred living donor livers are implanted each year.
In the United States, more than 113,000 people are on the waiting list for organ transplants, most of them in search of kidneys. Others are too sick to appear on the list or are removed from the list when their disease progresses too far.
Until now, leaving an HIV-positive person with a single kidney was considered too dangerous because the infection and the drugs that control it increase the risk of kidney disease.
However, a 2017 study of 42,000 people conducted by Hopkins researchers showed that for some healthy HIV-positive donors, the risk of developing severe kidney disease is not much greater than for many HIV-negative people, especially those who smoker.
The Martinez organ was implanted in the recipient by a separate team of surgeons, the normal procedure in transplantation. The operation was performed by Niraj Desai, Assistant Professor of Surgery at Hopkins.
The kidney was implanted near the recipient's pelvis through an abdominal incision of six to eight inches, and the kidneys of the recipient were not removed, as the practice requires usual, explained Desai. Kidney transplant recipients can expect 20 to 40 years from a transplanted kidney, according to Segev. Those who receive a live kidney donation will do a little better than those who get the organs of a deceased donor. After this period, the recipient would need another transplant or return to dialysis, he said.
Martinez and the recipient will continue on antiretroviral therapy indefinitely to control their HIV. Because they can have different strains of the virus and different resistance to anti-HIV medications, doctors must monitor the recipient closely within months of the introduction of the donor's organ. The recipient will also take medication to prevent rejection of the organ. These should not interfere significantly with the drugs that suppress HIV.
Martinez has an almost normal physical health. His viral load is undetectable. "Her health is excellent, her HIV is well controlled, her immune system is essentially normal," said Christine Durand, badociate professor of medicine at Hopkins and a member of Martinez's evaluation team.
In 1983, Martinez and her twin sister were born 12 weeks prematurely in San Jose and quickly developed anemia. The daughter of a naval officer, Martinez was taken to a San Francisco military hospital for a blood transfusion a few days before the HIV test, and she contracted the infection. She and her family were unaware of anything until she was examined before eye surgery at the age of 8 years.
She was monitored at school to make sure she did not endanger the health of the other children, she said. She later learned that a school principal had asked, "Why are we educating her with public money if she will die?"
When a roommate found out that she was HIV positive, he left leaving his belongings behind.
"It gives me great joy to know that I'm telling a story like this," she said. "Because these people need a mental restart."
A public health consultant residing in Atlanta, Martinez was aware of the adoption in 2013 of the law on the equity of HIV organs, law authorizing the operation. The following year, she saw an episode of the television show "Gray's Anatomy" whose authors invented the story of a living donor transplant living with HIV.
When an HIV-positive friend needed a kidney, Martinez became more serious about this idea and contacted Hopkins for what he volunteered for the exhausting test pattern that allowed him to become the first donor of his clinical test. But Martinez's friend died before she could give him a donation.
She thinks that her choice will reduce the waiting list for transplants.
"When I remove this recipient from the list, everyone is progressing, whether they are HIV-positive or not," she said.
2019 © The Washington Post
This article was originally published by The Washington Post.
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