When someone is dying, you treat what is killing them first.
This might seem obvious, but its not– People wondered ‘If we can cure people of HIV with bone marrow transplants, then why dont we give everyone bone marrow transplants??’
We can only give HIV+ people with blood cancers that are killing them bone marrow transplants, because of the risks involved in the procedure. Bone marrow transplants are non-trivial. They can kill someone. So unless a cancer is killing an HIV+ person, it isnt worth the risk.
Furthermore, when someone got a bone marrow transplant, traditionally, they were taken off antiretroviral therapy. Why? Because ARVs are hard on your body… and so is surgery, radiation, chemo, etc. Because the cancer is what is posing the immediate threat, people are taken off ART, and the physicians focus on treating the cancer. Turns out if the patient can handle the cancer treatment on ART, it is great, but we didnt know that before.
Likewise, this is one of those times where I would normally be against something, but the ‘its killing someone’ hierarchy overrides my objections:
HIV+ people who, lets say die in a car crash, cannot donate their organs. Obviously. We dont want to infect HIV- people with HIV.
There are lots of HIV+ people waiting for organs too. Why not take organs from HIV+ people and give them to other HIV+ people so it isnt a total waste?
“ARG!!!” my brain screams. “Thats a horrible idea! All HIVs are not the same! The person needing the organ might be controlling virus just fine, but the new HIV might be more pathogenic, might cause more damage, might be drug resistant, ARG!”
… But if you are HIV+ and about to die because you need a liver transplant… are you willing to take that risk? What does that risk actually look like?
That is where the HOPE act comes in.
Passage of this act does not mean HIV+ people can donate organs, or accept HIV+ organs today. What they are doing, is *exploring* HIV+–>HIV+ organ donations. What does happen to the patients? What are the risks? We have no idea. It might be a risk worth taking that can save lives– not just of HIV+ people waiting for organs, but HIV- people who would have a shorter wait time for organs as well.
The HOPE act lets scientists and physicians study HIV+–>HIV+ donations. If it works, YAY! If it does end up being bad for the HIV+ recipients, they will drop it.
I think its a great idea.