Researchers and clinicians at the UC
Medical Center were among the first in the U.S. to begin enrolling
patients in a National Institutes of Health trial evaluating the
protocol for liver and kidney transplantation for HIV-positive
patients. The trial is part of a multi-center study aimed at
determining the best way to manage HIV patients and guarantee long-term
survival. The first liver transplant in UC’s study was performed in
November at University Hospital. The recipient has since been released
and is doing well.
Since the availability of multi-drug
“cocktails” in the late 1990s, life expectancy for HIV-positive
patients has increased significantly. As a result, incidences of
chronic diseases have increased for these patients. Death from
complications of HIV has been replaced by increased death rates due to
liver disease. It is reported that liver disease has emerged as the
leading cause of death among HIV-positive patients in Western
“The use of medications active against
HIV has dramatically altered the landscape of this deadly disease. We
now rarely see development of AIDS. Instead, we see patients with
end-stage liver disease whose HIV is not even detectable in their blood
samples,” said Kenneth Sherman, MD, PhD, director of Hepatology at UC
and site principal investigator for the study.
While HIV-positive patients meeting
criteria for organ transplantation are already allowed to receive
transplants, there has never been an established multi-center protocol
for dealing with the preparation, procedure and follow-up that is
specific to this virus and its medications. Last month, the NIH
informed UC that they would be among the first of 14 centers to begin
enrollment in this study. UC is an international leader in the study of
HIV treatment and associated liver disease.
It is expected that 18 patients will be
enrolled locally in the study. This complex process has been performed
in less than 100 patients worldwide with varying success. The
transplant work-up, procedure, and subsequent care requires management
by a highly trained, multi-disciplinary team. This team includes the
following faculty members:
Judith Feinberg, MD, professor in the
Department of Internal Medicine/Division of Infectious Diseases. Dr.
Feinberg leads the HIV/AIDS clinical research at UC and is the
principal investigator for the AIDS Clinical Trials Unit, which has
been continuously funded by National Institutes of Health since 1987.
Frederick L. Weber Jr., MD and Stephen D.
Zucker, MD, associate professors in the Department of Internal
Medicine/Division of Digestive Diseases. As Co-investigators for the
study, Drs. Weber and Zucker will participate in evaluation and
Rita Alloway, PharmD, research professor,
Department of Internal Medicine/Divison of Nephrology and Hypertension.
Alloway is a pharmacologist with expertise in the interactions between
the immunosuppressive medications needed in the transplant setting and
the HIV treatment medications.