Wednesday, December 31, 2003
Better treatment for HIV has made more people eligible for transplants.
CINCINNATI (AP) -- After living 20 years with a combined HIV and hepatitis B infection, musician Terry LaBolt was weakening and at risk of dying.
But he's been revived by a liver transplant under a nationwide clinical trial for people infected with the HIV virus.
"Just inhaling one breath is like 100 times the oxygen I used to get," said LaBolt, 48.
The pianist is eating better than he was before his Nov. 19 transplant and is considering returning to his musical career, which has included Broadway and television shows.
"I was so scared he was going to die," said Carol Sherman-Jones, a close friend. "Every time I'd kiss him goodbye, I'd think, 'Is this the last time?'"
But LaBolt lived long enough for medical science to catch up to his illness.
He became the first HIV-positive person in the Cincinnati area to receive a liver transplant, and now he's expected to have as good a chance at long-term survival as any other liver transplant recipient.
"This study challenges a lot of assumptions," said Dr. Ken Sherman, a liver disease expert coordinating the University of Cincinnati's role in the national study.
"As long as the patient does not have active AIDS, they can be transplanted. Life expectancy for HIV-positive people is not different from other transplant patients."
Shift in policy
In the years after AIDS emerged worldwide in the 1980s, people with HIV were rejected for organ transplants because they weren't expected to live long enough to justify it.
Since then, antiviral therapies have become so successful that liver damage has emerged as one of the leading causes of death for people with HIV, who also can be infected with liver-damaging hepatitis B and C viruses.
Even so, HIV patients weren't transplant candidates until recently because doctors feared post-surgery anti-rejection drugs could interfere with HIV medications.
LaBolt's transplant was part of a clinical trial run by researchers at the University of California, San Francisco.
The University of Cincinnati is among 14 participating medical centers.
The study calls for performing 130 liver transplants on people with HIV over the next three years, including nine in Cincinnati.
That is fewer than 1 percent of the more than 15,000 liver transplants expected to be performed nationwide in the same period.
The goal is to pin down which HIV-control drugs work best with anti-rejection drugs and which medicine combinations should be avoided after a transplant.
Nationwide, 17,679 people are listed on liver transplant waiting lists, according to the United Network for Organ Sharing.
Through September, 4,244 liver transplants had been performed this year.
Researchers say it's too early to tell how many people of the 900,000 Americans with HIV will get sick enough in a given year to need a liver transplant.
Before this study began, about 50 people with HIV got new livers from 1997 through 2002 from transplant centers in San Francisco, Pittsburgh, Philadelphia and Miami.
Reinvigorated
LaBolt said his life is transformed.
"Just getting up the steps took all the energy I had," he said. "But when I woke up from surgery, my biggest problem became what to do with all the energy."
LaBolt's musical career has taken him to Broadway, on concert tours with Carol Channing and to performances on several television shows.
He taught musical theater for several years at the University of Cincinnati's College-Conservatory of Music. Until recent months, LaBolt occasionally performed at fund-raisers and events.
He stayed alive by taking at least 12 different medications to control the viruses attacking his body and prevent infections that could kill him.
To ease the burden on his liver, he followed a strict low-sodium and low-protein diet. Even so, his health was steadily failing before the transplant.
"It says that the medical community is looking at people with HIV in a different way than they have in the past," said Kathryn Thompson, education coordinator for AIDS Volunteers of Cincinnati.
"I've known Terry for nine years. I have never heard the energy in his voice that he has now. He will be an inspiration to others who may think they'll never feel good again."