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As mentioned above, HAART enables HIV/AIDS patients to live longer lives. Today, most patients with HIV/AIDS are dying from end-stage organ disease and organ failure rather than AIDS-associated opportunistic infections. Since HAART prolongs the lives of HIV patients, it is possible for chronic conditions to progress to organ failure. For instance, HIV patients may experience end-stage liver disease as a complication of chronic hepatitis C virus. Glomeruli diseases are also common among HIV patients, and they may lead to kidney failure. In advanced stages of liver or kidney damage, organ transplants may be the patient's only chance of survival.
Until recently, people who had HIV were not considered good candidates for organ transplantations. Many patients were denied transplants under the assumption that they had shorter life expectancies and less favorable survival rates than other patients in need of transplants. However, now that patients are living longer lives, many groups are re-considering whether HIV patients should be transplant candidates.
Although the United Network for Organ Sharing (UNOS) does not consider HIV infection a contraindication for organ transplantation, individual transplant centers are in charge of deciding whether or not to perform surgery in an HIV-positive patient. Some centers will not provide organ transplants to HIV-positive patients, even if they are good candidates based on their physical and mental health.
Some health insurance companies are reluctant to cover transplantation in HIV-positive candidates because they consider it to be an experimental procedure. Currently, only a few medical centers worldwide perform organ transplants in HIV-positive patients. However, health insurance companies and doctors consider organ transplantations in HIV-negative patients to be a well-established, reimbursable procedure.
Recent legislation in California and a ruling in Arizona may help increase HIV patients' access to transplant surgery. In October 2005, an administrative law judge declared that Medicaid had to pay for a liver transplant for an Arizona woman who was HIV-positive. In the same month, California Governor Arnold Schwarzenegger signed a law that prohibits health insurance companies from denying coverage for organ transplants in HIV patients solely on the basis of their HIV-status. The law is the first of its kind to target such denials.
The limited number of transplants that have been performed in HIV patients have produced encouraging results. However, organ transplants for people with HIV/AIDS have not gained widespread medical support, and there are still concerns regarding the long-term prognosis for HIV-positive transplant recipients.
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