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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 17, Issue 1, Pages 15-18

Ethical and Scientific Issues Surrounding Solid Organ Transplantation in Hiv-Positive Patients: Absence of Evidence Is Not Evidence of Absence

Timothy Christie,1,2,3 Bashir Jiwani,4,5 Getnet Asrat,1,2,3 Valentina Montessori,1,2,3 Richard Mathias,2 and Julio Montaner1,2,3

1British Columbia Centre for Excellence in HIV/AIDS, Canada
2University of British Columbia, Canada
3Providence Health Care, Vancouver, British Columbia, Canada
4University of Alberta, Edmonton, Alberta, Canada
5Fraser Health Authority, Surrey, British Columbia, Canada

Received 10 November 2005; Accepted 10 November 2005

Copyright © 2006 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


End-stage liver disease is emerging as a leading cause of death among HIV-positive patients. Historically, an HIV diagnosis was a contraindication for a liver transplant; however, because of the efficacy of highly active antiretroviral therapy (HAART), HIV-positive patients have one-year, two-year, and three-year post-transplantation survival rates similar to that of HIV-negative patients. Based on this evidence, HIV-positive patients are now considered eligible for transplantation. However, newly emerging guidelines include the stipulation that HIV-positive patients must be on HAART to be placed on a waiting list for transplantation. The purpose of the present paper is to evaluate the scientific and ethical probity of requiring HIV-positive patients to be on HAART as a condition for being on a liver transplant waiting list. It is argued that the emphasis should be placed on the probability of post-transplantation HAART tolerance, and that concerns about pretransplantation HAART tolerance are of secondary importance.