Debbie Knight

Patient who got AIDS from a transplanted kidney: a tragedy with a silver lining?

In observation on March 18, 2011 at 12:19 pm

Human immunodeficiency virus (HIV), colour-enhanced electron microscope image, 24,000× magnification. Oliver Meckes and Gelderblom/Art Resource, New York

Can good come from tragedy? I certainly hope so.

In this morning’s newspaper, I read about the first documented case in which a patient got AIDS from a transplanted kidney.  Perhaps it might be more accurate to say that the patient contracted HIV from the transplanted tissue and because transplant patients are immunosuppressed, the HIV infection rapidly progresses to AIDS.

My first reaction to the story was dismay at the tragedy and sadness for the patient and family members. Then I got angry at the donor for not letting anyone know that there was a risk of HIV transmission. And then angry at the system for allowing this incident to happen by not testing the donor closer to the time of transplantation. And I eventually rolled over to sadness for the donor because not only does this person have to live with HIV, but he or she has to live with the knowledge that he or she passed it on to the recipient.

Then the scientist took over – the part of me that looks for what good can come of a situation such as this. I should mention that until last month I worked in a research lab that looked at how HIV is passed from mother to baby while the baby is still in the womb. I should also mention that I understood that the placental tissue samples that I used in the research came from real people with real lives, specifically mothers who were HIV-positive who may have given birth to babies infected with HIV – two tragedies with a very sobering outcome.

So, as I read the news article this morning, I realized that this unfortunate transplantation situation might be able to give researchers a unique glimpse into HIV’s lifestyle.

Okay, first I need to tell you that HIV mutates rapidly, a product of its replication machinery, and because it mutates so quickly, an infected person has many versions of the virus that differ slightly from one another due to these mutations. Some of these mutations make the virus more successful at replicating than other copies. Other mutations make the virus better at evading the host’s immune defenses. Of course, this is highly simplified, but you get the idea.

So, when someone’s infected with HIV through unprotected sex, like our donor, only one or two versions of the virus pass from the infected person to the uninfected person. The article mentioned the donor may have been infected 11 weeks prior to the kidney transplant, so that gives the HIV a chance to get a foothold and to make some mutated copies. So, when the kidney was transplanted, it probably harbored the same virus pool that was found throughout the HIV-infected donor. So the recipient had the approximately the same virus pool as the donor and the recipient was purposefully immunosuppressed to preserve the transplanted kidney.

The big question is:  what will happen to the components of the virus pools in these two individuals over time?  I suspect the viral pools would be very different – one would change more rapidly than the other, due to selection pressure exerted by the immune system.

Information such as this might help further understanding in how the virus evades as well as exploits the immune system during its life cycle. It could also help predict how the virus pools might change over time, perhaps even offer itself to computer modeling, and perhaps lead to better therapeutic strategies for HIV.

As a scientist I never wish for such a tragic situation, nor do I drool like some freakish vampire waiting for a patient with whatever disease I’m studying to pop up on the grid.

I always remember that the specimens I have in my hand are from a real person with a real disease and a real life, and my heart goes out to the patient as well as the family. This drives me to work even harder to understand the disease which might lead to a therapy or cure, so that some good can come from their sacrifice.


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