First Ever HIV-Positive To HIV-Positive Transplant Takes Place In Baltimore

On Monday, an Atlanta woman made history by become the first HIV-positive kidney donor in the world when surgeons at Johns Hopkins Medicine in Baltimore transferred her organ to a patient who is also HIV-positive, according to a statement from the hospital. The operation was a success, and both patients are doing well.

Nina Martinez, 36, is a public health consultant who became infected with the HIV virus when she was six years old through a blood transfusion. Despite living with HIV, she has survived and thrived. "I really want people to reconsider what living with HIV means," she said. "If anyone is proof that you can live a lifetime with HIV, that is myself. I've been living with HIV for 35 years -- pretty much the length of the epidemic in the United States."

Dr. Dorry Segev, a professor at Johns Hopkins University School of Medicine, is the surgeon who performed the transplant. He praised Martinez’s bravery and said the surgery is "really a celebration of HIV [medical] care and its evolution."

Until 2013, the United States did not allow HIV-positive organ donations, Segev said, "I was watching people with HIV die on our transplant list, and I was watching us have to decline every single potential donor, whether deceased or living, just because they had HIV."

HIV donor transplants were also not considered viable since the virus may damage the kidney, and antiretrovirals are toxic to the kidney. "We had to show that certain people with HIV could be healthy enough to be a kidney donor and to live with only one kidney," Segev said.

Nowadays, as people live with HIV as a chronic illness rather than a death sentence, they are faced with more kidney failure as a result of high blood pressure, diabetes and heart disease. "Because people living with HIV are disproportionately impacted by the length of the donor wait list, if you are living with HIV, you are nearly twice as likely to pass away while waiting for a kidney." Martinez said.

The HIV Organ Policy Equity (HOPE) Act, which was passed in November 2013, enabled researchers to study organ transplants from HIV-positive donors to HIV-positive recipients. The act does not prioritize HIV-positive patients, but it has created a pool of HIV-positive donors. The states, which had passed laws restricting donations from people with HIV, must now conform to federal standards.

In 2016, Johns Hopkins performed the world's first HIV-to-HIV transplant, though the organ was taken from a deceased donor. So far, there have been nearly 100 HIV-to-HIV transplants in the United States, yet Martinez is the first living donor.

"It wasn't until my friend broadcast his need for a kidney that I seriously thought about this in earnest," she said. "Unfortunately, my friend passed away." Martinez was still determined to donate so she was matched with someone from Johns Hopkins' kidney wait list.

"Nina met the standard donor criteria: She was otherwise healthy without hypertension, without diabetes, so her only additional risk factor for kidney disease was HIV. And we had determined from our research that that was an acceptable and small additional risk," said Dr. Christine Durand, associate professor of medicine and oncology and member of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and the HIV team specialist for Martinez's surgery.

Martinez said that she has lived this long thanks to access to health care. She also exercises, walking and running marathons with the nonprofit Grassroots Project, which teaches young people how to prevent HIV prevention. "I thought the juxtaposition of a longtime HIV patient with NCAA Division I athletes was quite comical," she said.

Martinez's HIV is also under "excellent control," and the virus is undetectable in her blood, said Durand, who added that "the medically novel part of this is that the recipient will likely acquire a second strain of HIV from the donor -- something that we call HIV superinfection." This means that donor and recipient have to be compatible in terms of HIV drug resistance in order for their drug regimen to still work.

"We can, if we need to, change a recipient's medication around, but we have to have a plan for that going into it," Durand said, remarking that there are "more than 20 available HIV medications." The patient will also receive immunosuppressant drugs to prevent rejection of the transplanted organ.

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Today, there are more than one million people living with HIV in the United States. Martinez's operation means that “there's one less stigma associated with this disease," Segev said.

"I have a really strong sense of faith in myself, like I am my own rock. And so whenever I've made kind of unusual decisions or decisions where I don't know the outcome, I just hunker down and believe in myself, and usually, that will get me through. Some people might call that stubborn," Martinez said.

She hopes her donation will inspire others, regardless of their HIV status, to become donors. "We have a very serious organ shortage in this nation. It's a real concrete way to make a difference," she said.

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