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Tranplant patients contract H.I.V.

Four transplant recipients in Chicago have contracted H.I.V. from an organ donor in the first known cases in more than a decade in which the virus was spread by organ transplants.
The recipients also were infected with hepatitis C, which health officials said was the first reported instance in which the two viruses were spread at the same time by a transplant.
Though cases like this are exceptionally rare, they call attention to a known flaw in the system for checking organ donors for infection: the most commonly used tests may not detect viral diseases if they are performed early in the course of the infection.
Officials with the Centers for Disease Control and Prevention said the incidents may lead to widespread changes in testing methods of transplants.
The cases were first reported on Tuesday by The Chicago Tribune. Two patients were infected at the University of Chicago Medical Center, and one each at Rush University Medical Center and Northwestern Memorial Hospital.
While officials would not say which organs were transplanted, no other tissues were taken from the donor.
The University of Chicago said that the transplants took place in January, and that the adult donor died in an Illinois hospital “three days after traumatic injury.?
The other hospitals confirmed that each had an infected patient but declined to discuss what happened.
When one of the recipients, who was being evaluated for a retransplant, tested positive for H.I.V. and hepatitis C, blood preserved from the donor was found to be infected after it was given a highly sensitive test for viruses. The Chicago Tribune said that the patients didn’t learn until the last two weeks that they were infected with H.I.V. and hepatitis C.
According to Dr. J. Michael Millis, the chief of transplantation at the University of Chicago, the diseases were treatable.
The New York Times reported that, according to the University of Chicago, the organ donor was identified as “high risk,? based on a risk factor revealed by a “close friend who provided a health and social history.?
The Chicago Tribune said that officials with the Gift of Hope Organ & Tissue Donation, the Elmhurst agency that tested and approved the organs for donation said a screening questionnaire determined that the organ donor had engaged in high-risk behavior.
Infections can be missed by the typical tests if patients have contracted H.I.V. up to 22 days before being tested, with the window even longer for hepatitis.
Federal guidelines recommend against using transplant 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? (The New York Times).
About 9 percent of organ donors qualify as high-risk because of behaviors like drug use with needle-sharing or prostitution.
The New York Times said, “It has always been known that this kind of transmission was theoretically possible, but it was considered highly unlikely. Considering that since 1994 nearly 300,000 transplants from cadavers have occurred without any reported cases of H.I.V. transmission, infections are very rare.

The New York Times:
http://www.nytimes.com/2007/11/14/health/healthspecial/14hiv.html?ref=us

The Chicago Tribune:
http://www.chicagotribune.com/services/newspaper/printedition/tuesday/chi-organ13nov13,0,7359947.story