MUMBAI: Susheel Jha has had an unusual experience with the human immunodeficiency virus (HIV). A resident of the central suburbs, he proudly announces unlike many HIV-positive patients, he has never been bedridden by frequent bouts of illnesses.
He credits his health to his family and hisemployer, the Indian Railways, who have been supportive ever since he was diagnosed with HIV while randomly donating blood at a donation camp way back in 1997.
The unusual patient scaled another height three months back; he became the first HIV-positive person in Maharashtra to undergo a kidney transplant. In the stigma-ridden world of HIV/AIDS, 45-year-old Jha's story holds out hope for the two-million-plus Indians living with HIV.
In Jha's case, his 64-year-old mother Sitara donated one of her kidneys to her first-born son. "I just want to see my child living healthily next to me," she said over the phone from Benares.
The transplant is a milestone of sorts. Not surprisingly then, Jha's nephrologist Dr M Bahadur, transplant surgeon Shailesh Raina and medical consultant Dr Om Srivasatava are ecstatic with his progress since the transplant was carried out at Jaslok Hospital last November 26.
"This is the first time in Maharashtra that a HIV-positive person has got a transplant. It needs experienced specialists to manage the patient carefully so as to ensure that his body doesn't reject the donor organ while ensuring that the HIV infection doesn't flare up," Bahadur, who has been treating Jha since 2006, said.
Admitting that it had indeed been a challenge to handle a HIV-positive patient, Srivastava said that the right medical environment (as in a super-speciality hospital like Jaslok), right protocol and medicines were needed for such transplants. "If the HIV-positive patient's CD4 count is adequate and his viral load is negative, then he can safely undergo a transplant," added the Jaslok doctors.
Worldwide, too, transplants for HIV-positive patients are a relatively new concept. In 2004, the US reported about a 100-odd liver and kidney transplants for HIV-positive patients.
The man himself is calm. "My HIV status was detected in 1997 and my kidney failure in 2006." He was on dialysis for three years before doctors realised that transplant would be the only hope for him. "In my 13 years with HIV, I took only 77 days of leave but I needed over three months of leave for the kidney transplant and the minor problems that cropped up after it," he said.
Jha also believes that his employer, the Railways, played a great role in his "healthy but HIV" status. "I have had access to antiretroviral drugs for the past 10 years. I was never discriminated against or passed up for promotion at my workplace. My dialysis would cost tens of thousands of rupees but the railways always paid up. They even paid for my transplant," added the father of two.
Dr Harsh Jauhari, one of the seniormost nephrologists in the country, said that while a couple of HIV-positive patients had undergone transplants in India, little was chronicled about these special patients. "There is a confidentially clause with HIV-positive patients that cannot be tampered with. So it is likely that we don't know about all the transplants that have taken place in this category. But there is no denying that these patients need specialised care," added the Delhi-based Jauhari.
Another senior doctor said there were several issues about safety about the medical staff involved as well that had not allowed HIV-positive transplants so far.
Incidentally, a study published in the Archives of Surgery last year by the Johns Hopkins University School of Medicine said that HIV-positive kidney transplant recipients could have the same one-year survival rates for themselves and their donor organs as those without HIV, if certain risk factors for transplant failure were recognized and tightly managed.
According to the report, "HIV patients were earlier not considered transplant candidates as researchers thought that the survival rates after transplantation were greatly compromised by the disease, which cripples the body's immune system. Also, transplant patients take drugs that suppress their immune systems in order to prevent organ rejection, a regimen thought to further threaten their already fragile immune systems."
(The patient's name has been changed.)
