Organ Transplant Leads to 4 HIV and Hepatitis Co-Infection

A disturbing report from 365gay.com about a bizarre case of four people infected with HIV and hepatitis through organ transplants from a "high risk donor" in Chicago, Illinois. From the New York Times report:

Initially, the donor had tested negative for both H.I.V. and hepatitis C, apparently because the infection was too recent to be detected by commonly used blood tests. Those tests do not find the virus itself, but instead look for the body’s reaction to the infection — antibodies, produced by the immune system. But the body takes time to react, and if the test is done too soon, within 22 days of H.I.V. infection or 82 days for hepatitis C, antibodies may not yet be detectable. Doctors say that is what probably occurred in Chicago.

It has always been known that this kind of transmission was theoretically possible, but it was considered highly unlikely. And indeed, since 1994 nearly 300,000 transplants from have occurred without any reported cases of H.I.V. transmission.

Another, more sensitive type of test can pick up viral infections earlier, but was not used. That test looks for evidence of the virus itself, and can reduce the “window,” the early period in which the test does not work, to 12 days for H.I.V. and 25 days for hepatitis C. That test, called the nucleic acid amplification test is not widely available, and doctors said that it was more difficult and time-consuming than other tests and that there is usually no time to spare with transplants because organs deteriorate quickly when the donor dies.

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According to the University of Chicago, the organ donor in Illinois, an adult, was known to be “high risk,” based on a risk factor revealed by a close friend who provided “a health and social history.” The exact nature of the risk was not disclosed. Federal guidelines recommend against transplanting organs from high-risk people unless the recipients are so likely to die for want of a transplant that H.I.V. seems a lesser threat.

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There is a shortage of organs for transplant, and many patients die waiting. Currently in the United States, 98,000 people are on the transplant list, but only about 19,000 transplants have been done this year. Last year, 7,200 died waiting.

In 2005 Governor Schwarzenegger signed into law a bill that prohibited discrimination in the provision of medically necessary organ transplants based on the HIV status of the recipient.