Wits University doctors have conducted South Africa’s first HIV positive organ transplant to an HIV negative recipient‚ giving a liver to a 13-month who otherwise would have died.
The baby was born HIV negative from a positive mother‚ but had a liver disease.
The infant was dying and had waited more than 180 days for a liver.
“The window of opportunity [to save the life] was closing‚” said Jean Botha‚ head of transplantation at Wits Donald Gordon Hospital.
Because of a shortage of organs‚ Wits started a living liver donor programme from 2013‚ he explained.
“The availability of organs has not kept pace with unrelenting demand.”
Botha‚ a surgeon‚ said a living donor’s liver returned to the original number of cells within six to eight weeks after a segment of it was donated‚ so it didn’t disadvantage them.
But all donors used in the programme have been HIV-negative.
The University of Cape Town already uses HIV-positive organs from deceased donors for living patients who are HIV positive.
Scientists believe this is the first time worldwide that a positive organ has been used for a negative person.
Scientists consulted widely to determine if it was ethical and an ethical committee at Wits made the decision to go ahead‚ taking into account the child’s family’s wishes.
“The child would otherwise have died‚” said Botha.
The child was given preventative antiretroviral treatment the night before the operation‚ which took place in 2017 – and afterwards to prevent HIV.
They didn’t know if the preventative treatment would work when transplanting an HIV positive organ‚ said HIV specialist doctor Francseca Conradie.
Tests picked up HIV-antibodies in the baby‚ meaning it could be positive – but these could also come from the mother’s liver as a liver stores many immune cells.
Other tests could not find any virus in the body‚ but the ARVs could be stopping the virus from showing up‚ scientists explained.
A sophisticated test to look for HIV DNA cannot detect it and scientists explained that if the toddler was positive‚ they think these sophisticated tests would detect HIV DNA.
Scientists may have to stop ARV medicine to see if the baby is negative‚ but the doctors don’t want to do it yet.
“For now the child is well and we will leave it‚” said Conradie.
“We saved a child’s life‚” she said.
The family has asked to remain anonymous and none of their details will be given‚ said the team of Wits scientists.