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South African doctors say they grafted part of the liver of an HIV-positive mother to her seriously ill but seronegative child, concluding that the chances of saving a life exceeded the risk of transmitting the virus.
The mother and the baby have recovered after the transplant in 2017, but it is not yet known if the child is carrying the virus that causes AIDS, according to the team at Wits Donald Gordon Medical Center. of Johannesburg.
The experts at the University of the Witwatersrand explained the procedure in an article published Thursday in the journal AIDS. The university said it would "act as the first intentional liver transplant in the world," from an HIV-infected donor to a virus-free recipient, and that its success opens the way to "a new potential pool of living donors that could save new lives." "
Medications provided to the child before the transplant could have prevented HIV transmission, although this will only become clear over time, experts said. The liver of a donor not infected with HIV was not available in a country where there is a chronic shortage of organs available for transplantation.
"The transplant team faced the dilemma of saving the child's life knowing that the child could become HIV positive because of this decision," said the university.
The mother, who was taking antiretrovirals to fight HIV, had repeatedly asked if she could donate part of her liver to save her child's life and the medical team explained the risks of "living liver donation", according to the same source. at the University. The organ is able to regenerate and become complete again.
"In the weeks following the transplant, we thought that the child was HIV-positive because we detected anti-HIV antibodies," surgeon-transplantist Jean Botha said in a statement. However, more tests done by HIV experts at the National Institute of Communicable Diseases of South Africa have not found active HIV infection in the US. 39; child.
South Africa has the largest antiretroviral treatment program in the world, improving the lives of many people living with HIV.
South African doctors had to take into account that with the current improved HIV medications, the child could "lead a relatively normal life" with a pill a day even if he was infected, according to Dr. Anthony Fauci, head of infectious diseases at the US National Institutes of Health and a leading expert on HIV.
"If it's a choice between death and a reasonably good life with a treatable infection, I think they've made a perfectly reasonable choice," he said.
But Fauci pointed out that a case does not mean that the approach is ready to be tried again: "Everything must be done on a case by case basis."
In some cases, HIV-infected organs have been unintentionally transplanted to seronegative patients. And in the United States, Johns Hopkins University has in recent years been a pioneer in the transplantation of HIV-positive transplant donors. Still in the United States, tests are underway on organs infected with hepatitis C, thanks to new treatments for hepatitis.
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Associated Press reporter Lauran Neergaard in Washington contributed.
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