HIV heart transplant success

HIV patients should be considered for transplants, say experts

An HIV-positive man is alive and well two years after getting a new heart.

The operation, reported in a leading medical journal, is as much a symbol of changing attitudes among doctors to HIV patients as a technical breakthrough.

The prospect that many HIV-positive patients, with modern combination therapies, will live for many years after diagnosis, means that they are increasingly being considered as candidates for transplant organs.

The patient in question, Robert Zackin, had a failing heart due to the powerful anti-HIV therapies he had been taking.

He had become infected with HIV in 1986, and diagnosed in 1992.

Even though his CD4 count - a key measure of immune health in HIV patients - was at rock bottom in 1994, a new generation of drugs kept the virus at bay.

It's been two years with a high quality of life. That's a lot to get out of a transplant

Dr Leonard Calabrese, Cleveland Clinic

However, when it became clear that his heart was failing, in 2000 he started looking for a heart transplant, but was turned down by several hospitals until the Cleveland Clinic accepted him in January 2001.

He received the new heart weeks afterwards.

Dr Leonard Calabrese said that earlier transplants involving HIV patients receiving new livers and kidneys had shown what was possible.

He said: "We've gone from giving people with HIV a pat on the back and watching them die to being able to treat infections, to now having the prospect of transplanting a vital organ such as a heart.

"It's been two years with a high quality of life. That's a lot to get out of a transplant."

He said that a greater debate was needed on whether HIV-positive patients should be eligible for heart transplantation.

"Twenty-five years ago, people would have said the same thing about a diabetic."

Diabetics are now regularly considered for transplants.

Jack Summerside, from Terrence Higgins Trust, said: "This is welcome news for people with HIV.

"It's part of a much wider shift in the recognition of the ongoing medical and health needs of this group - improved treatments mean longer life and also greater opportunities for other health problems to arise.

"It's important to understand that this patient's heart condition was actually caused by his treatment for HIV - he did not coincidentally happen to have a heart problem.

"This emphasises the need for continuing research into improving HIV treatment, as current options are far from ideal."