title: Ethical and scientific issues surrounding solid organ transplantation in HIV-positive patients: Absence of evidence is not evidence of absence.
abstract: 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.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS.
authors.forename: Timothy
authors.initials: T
authors.lastname: Christie
authors.forename: Bashir
authors.initials: B
authors.lastname: Jiwani
authors.forename: Getnet
authors.initials: G
authors.lastname: Asrat
authors.forename: Valentina
authors.initials: V
authors.lastname: Montessori
authors.forename: Richard
authors.initials: R
authors.lastname: Mathias
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner