UP EXPERT OPINION: Increasing HIV-positive donors in stem cell transplantation

Posted on October 31, 2023

In an HIV-endemic area like South Africa, where over eight million people are living with HIV, the need for haematopoietic stem cell transplantation (HSCT) is significant, but there's a shortage of suitable donors. Both stem cell and solid organ transplantation have shown success in people with HIV.

Dr Candice Hendricks (paediatric haematologist) and a team from the Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences at the University of Pretoria recently published a paper exploring the possibility of including people living with HIV and umbilical cord blood from HIV-negative infants exposed to HIV as donors for stem cell transplantation.

Stem cell transplants offer a lifeline to patients battling life-threatening haematological conditions. For many, finding a suitable donor can be a daunting challenge. The Institute for Cellular and Molecular Medicine at the University of Pretoria is taking a bold step to change this narrative.

Due to a diverse population, matching donors for patients can be especially challenging. That's why we are urging individuals from all walks of life to consider becoming donors. Scientific advancements and careful protocols ensure that HIV-positive individuals can be completely virologically supressed, and can therefore potentially donate stem cells safely, provided all the risks have been explained to both donor and patient.

A case of a liver transplant from an HIV-positive mother to her HIV-negative child performed at an academic hospital in Johannesburg highlighted the complexities involved in determining the HIV status of solid organ transplant recipients. There has been no documented case in the literature of a person living with HIV being a bone marrow stem cell donor for an HIV-negative patient.

Particular challenges when considering transplantation from a person living with HIV to an HIV-negative recipient include ethical considerations, weighing the risk of potential HIV transmission against the risk of disease progression and death, and ensuring the autonomy of both the donor and patient. Additionally, medical complexities involve considering the potential impact of antiretroviral exposure in the donor post transplantation, lifelong treatment costs and drug interactions. Balancing these factors requires careful consideration and thorough evaluation by medical professionals and ethical committees.

In the context of HIV and haematopoietic stem cell transplantation (HSCT), it's crucial to prioritise donor safety and decrease the risk of disease transmission to recipients. HIV-positive donors are usually excluded, but studies show that HSCT can be successful for HIV-positive recipients without increased risks. However, there are challenges, including infections and potential inadequate immune reconstitution.

Despite the risks, excluding HIV-positive donors in HIV-endemic regions like South Africa might not be practical. Clinicians need to guide decisions, emphasising thorough consent procedures and considering individual cases for transplantation.

In a region where HIV rates are high, considering umbilical cord blood from HIV-negative infants exposed to HIV for stem-cell transplantation is important. Antiretrovirals during pregnancy have significantly reduced HIV transmission to newborns. Tests confirm HIV status in newborns, but some cases might be missed due to lower viral loads caused by antiretroviral exposure. However, continuous research and medical advancements are aiming to eliminate these risks.

Umbilical cord blood, particularly from infants exposed to HIV, holds immense potential. It could be a safe, non-invasive way to donate stem cells and can significantly improve transplant accessibility. By considering these unique sources, we can enhance the chances of finding suitable matches for patients, ensuring more successful transplants.

Discussions are vital to consider HIV-positive individuals as stem-cell donors. Facilities establishing an HIV donor forum with a multidisciplinary team to address medical and ethical aspects for a holistic approach and better clinical outcomes are crucial to expanding donor options for patients who lack suitable matches for stem cell transplants.

 

How you can help:

Educate Yourself: Learn about the impact of stem cell transplants and the ways you can contribute. Speak to your doctor about your individual case and the possibility of becoming a donor.

Spread Awareness: Share this knowledge with your friends, family and colleagues to help dispel myths and encourage potential donors.

Consider Donation: If you're eligible, consider becoming a stem cell donor. Your decision could offer someone a second chance at life.

Join the conversation:

The Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences at the University of Pretoria encourages everyone to engage in this important conversation. By fostering understanding and embracing inclusivity, we can create a future where no patient is left without hope due to a lack of suitable donors.

Dr Candice Hendricks is a paediatric haematologist and researcher at the Institute for Cellular and Molecular Medicine in the Department of Medical Immunology in the Faculty of Health Sciences at the University of Pretoria. Professor Michael Pepper is Director of the Institute for Cellular and Molecular Medicine and research professor in the Department of Medical Immunology in the Faculty of Health Sciences at the University of Pretoria

Disclaimer: The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.

- Author Dr Candice Hendricks and Prof Michael Pepper

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