AIDS: first liver transplant from an HIV-positive mother to her child

To save her sick child, a mother with HIV donated part of her liver. A world first that took place in 2017 in Johannesburg, South Africa, and which was successfully held. One year later, the child shows no signs of infection.

The medical team at the University of the Witwatersrand in Johannesburg waited a year to reveal to the general public this great world premiere. Thursday, October 4, an article published in the journal AIDS tells us that last fall, a seronegative child with liver disease had a transplant of a particular kind.

It was her mother, the HIV carrier, who gave her this gift. Seropositive for several years, she was on triple therapy and therefore had an undetectable viral load. To save the child's life, the medical team had no choice but to graft a part of his mother's liver.

High risk of HIV transmission

According to France Info, the child was waiting for a liver transplant for 6 months and saw his health deteriorate. Hospitalized several times, his life was prognostic each time. In the absence of a compatible donor, the mother of the child offered to donate some of her liver.

But that was not without risk. Indeed, without detectable viral load, an HIV-positive person can not transmit the virus to a sexual partner. But this is not the case of an organ transplant, during which reservoir cells of the virus can be transmitted to the recipient. But even if the operation presented "risks of HIV transmission for the recipient", the medical team decided to perform the transplant because of the "exceptional circumstances". "Without a transplant, the child would certainly be dead," said the University of the Witwatersrand in a statement.

Faced with the risk of high contamination, the medical team however expected the worst. "In the weeks following the transplant, we thought the child was HIV-positive," says surgeon Jean Botha. A retroviral treatment was prescribed to the child before the transplant and it seems to work: to date, it shows no signs of infection. He is still taking anti-HIV treatment as a preventive measure.

New potential organ donors

For the doctor, the retroviral treatment "may have prevented HIV infection, and we will only know it definitively with time."

Indeed, the risk is that the virus will appear in the body in a few months or years, as it was the case in 2014. Born HIV positive in 2010, an American girl had received in the 30 hours that followed her intensive treatment with antiretrovirals for 18 months. Subsequent blood tests did not detect the presence of HIV. Not to mention healing - the virus did not disappear completely - doctors had then opened the promising trail of ultra-early treatment. But in July 2014, the researchers announced that the virus had reappeared in the girl, then 4 years old.

For doctors who performed the transplant from an HIV-positive adult with undetectable viral load, this "world first" is still a success. According to them, it offers new perspectives for patients who are in the desperate wait for an organ. "It presents a new pool of live donors that could save lives," say the researchers.

Video: HIV-to-HIV Transplant Media Briefing (January 2020).