HIV research: breastfeeding, kidney transplants

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New research published in the July 17 issue of the New England Journal of Medicine suggests promising developments in the battle against HIV and AIDS. In a study of more than 2,300 breastfeeding HIV-positive mothers, researchers from the University of North Carolina and the Centers for Disease Control and Prevention found that anti-retroviral drug regimes given to the mother and the child limited HIV transmission significantly. Another study, led by researchers at the Harvard School of Public Health, followed HIV-positive women from pregnancy through six months of their babies’ lives. They found that HIV transmission through breastfeeding was reduced by 99% when mothers took certain anti-retroviral drug combinations. And in the same issue of NEJM, doctors from Groote Schuur Hospital in Cape Town write about successful kidney transplants between HIV-positive donors and recipients.

In the U.S., HIV-positive mothers are generally given anti-retrovirals during pregnancy, and then encouraged to use formula to feed their children after birth. Yet, in many parts of the developing world — where the burden of HIV and AIDS is heaviest — there is not ready access to a clean water supply necessary to mix formula. If children are given contaminated water they face the risk for deadly infections and dehydration caused by diarrhea. If anti-retroviral regimes could make breastfeeding safer — as this latest research suggests they can — it could mean a world of difference for HIV-positive mothers struggling to protect their babies health and prevent HIV transmission.

For HIV-positive patients in South Africa, kidney failure is ultimately a leading cause of death. While, with routine dialysis, some of those patients might be able to survive, due to a lack of resources, too often such patients are “sent home to die,” Dr. Elmi Muller writes in this week’s issue of NEJM. That’s what drove Muller and colleagues at Groote Schuur Hospital to look for alternative solutions. And as the Associated Press reports, so far the team of Cape Town surgeons has performed nine kidney transplants between HIV-positive donors and recipients, the only such transplants that have been performed worldwide. Eight of those transplant patients are doing well.

Allowing HIV-positive donors to give organs to HIV-positive recipients could have a significant impact on the number of people living with HIV who are able to get organ donations. Yet HIV-positive patients are prohibited from donating organs in the U.S. — and experts say that the prevalence of drug-resistant HIV strains in the U.S. means that organ donation could put recipients at risk for exposure to a more dangerous strain of the virus. In South Africa, however, where drug-resistant HIV is less prevalent and there is less access to dialysis equipment and other treatment resources, organ donation may provide hope for many patients without other options.

According to the World Health Organization, 33.4 million people worldwide are currently infected with HIV, and 5.7 million of those people live in South Africa — more than in any other country.