HIV patients get new kidneys

For 29-year-old Ojus Paul (named changed) of Togo, it was a bolt from the blue when he was told that not only were both his kidneys damaged, but he was also HIV+. In the first place it was a fight to reach a place that would accept him for dialysis after knowing his HIV+ status.

Dialysis and funds were a struggle in his small French-speaking West African country. He underwent dialysis for two years before he learnt that kidney transplants on HIV+ patients are possible.

With a ray of hope he reached Egypt, only to be told that no kidney transplants are done on the HIV+ in that country. A disappointed Ojus returned to Togo, and through e-mail reached Narayana Hrudayalaya where he got a favorable reply.

Ojus promptly landed in Bangalore with the donor - his mother. Here, he was worked up in detail prior to the transplant. His HIV drugs were adjusted, the load of the virus in his blood was treated to undetectable levels and his immune cells (called CD4 cells) were brought to acceptable levels.

He was then vaccinated against various possible infections, and started on opportunistic infection-prevention prophylaxis. Immuno-suppressive medications were started a month prior to transplant to determine the right doses needed following transplantation.

Finally the necessary legal clearance from the Karnataka government committee was obtained before the transplant was carried out. Incidentally, the donor's kidney was removed through laparoscopic donor nephrectomy, a procedure which is less painful than conventional surgery.

Ojus's mother was overjoyed to see her son following her discharge on the third day after the surgery.

The story of 35-year-old Mohamed Sayeed (name changed) a nurse by profession from an East African nation, is no different. Although his HIV+ status was detected almost five years ago, dialysis was started about a year ago.

Sayeed faced additional complications as he experienced resistance to his HIV medication, causing the virus to multiply. Besides, he had two bouts of pneumonia and was also diagnosed to have tuberculosis of the lungs, needing prolonged therapy.

On arrival at Narayana Hrudayalaya, his viral load was reduced to undetectable levels with HIV therapy, and his immune CD4 cells were brought to the requisite levels prior to being considered eligible for kidney transplantation.

After going through a similar protocol as Ojus, Sayeed received a kidney from his wife. In this case too, the donor kidney was removed laparoscopically.

Ojus and Sayeed, now fit to go back to their home countries, are examples of how modern advances in medical care can help the HIV+ in whom organ transplantation was considered to be out of question until recently.

While mortality on dialysis is approximately 50% at two years, patient survival following transplant is about 90% at two years, which indicates that transplantation is the best way forward for HIV+ people on dialysis.

Incidentally, only two such transplants have been done earlier in India, one each at Delhi and Chennai. World over kidney transplantation in the HIV positive patients are on the rise in the well established centers.

The Narayana Hrudayalaya experience found that the post-transplant immune-suppressant drugs did not have any effect on HIV disease progression or markers of immunological function.

The main problem faced and tackled by the team after all the prolonged preparations, was the pharmacokinetic drug interactions between immune-suppressive agents and anti-retroviral agents used to treat the HIV patients.

"The take-home message is that HIV is not the issue, but the associated illnesses that occur with the immune-compromised state are the issue. In other words, no progression of HIV is found in any of the transplant recipients. Nor did we see an increase in the incidence of AIDS-related malignancies," said Dr
 Lloyd
 Vincent, Senior Consultant Nephrologist of the hospital.