Improvement Maintained for 2 Years After Cardiac Transplant in AIDS Patient

NEW YORK (Reuters Health) – A patient with advanced but controlled HIV infection continues to do well more than 2 years after receiving a heart transplant, investigators report in the June 5th issue of The New England Journal of Medicine.

The patient, who is a co-author of the Brief Report, was 39 years old when he received the transplant in February of 2001. After developing Pneumocystis carinii pneumonia in 1992, he was diagnosed with AIDS, at which time his CD4 count was 20 cells per microliter. He subsequently developed several opportunistic infections.

Antiretroviral therapy was initiated in 1992, and in 1995, he began treatment with protease-inhibitor-based therapy, resulting in an “excellent” response.

The patients was treated between 1994 and 1995 with liposomal daunorubicin for Kaposi’s sarcoma, but this treatment was halted when progressive shortness of breath developed and echocardiography revealed an ejection fraction (EF) of less than 25%. He was scheduled for transplantation after EF had declined to less than 10%, despite continuous dobutamine infusion.

The patient has experienced frequent episodes of rejection, but he is working full-time and exercising regularly.

In fact, co-author Dr. James Young told Reuters Health, the “rejection episodes we were seeing earlier on have lessened a bit. The one challenge is that he is anemic and requires frequent blood transfusions, but he looks great.”

Dr. Young, a member of the transplant team at the Cleveland Clinic Foundation in Ohio, noted that the antiretroviral regimen inhibits metabolism of drugs by the liver, so substantial dose-reductions in immunosuppressive agents were required.

“But what is most fascinating to me was that he was capable of mounting a rejection response at all,” he said.

Dr. Young added that the rejection episodes have “not been a terrible problem. If stacked against other transplant recipients, he may have had numerically more episodes, but the severity was less.”

N Engl J Med 2003;348:2323-2328.