8 ms·

Six transplant patients in Brazil contract HIV from infected organs

186 points by flykespice 2y ago

the_real_cher 2y ago
Its just bizarre to me how simple this is to avoid. Its one of the most common place tests in the world.
- wslh 2y ago
  Yes, incredible. When HIV/AIDS emerged, dentists were among the first professionals to adopt protective measures. I don't have more details than what's mentioned in the article, but situations like this can sometimes reflect a deeper issue within the underlying professional and organizational structures, almost as if they're "calcifying", not just negligence, but a symptom of how things are functioning beneath the surface. On the other hand, it might simply be a case of individual malpractice, though I think the latter will be rare in the context of transplants.
  - afh1 2y ago
    Rio isn't exactly known for its solid institutions or sanitary excellence.
- stevenwoo 2y ago
  Isn't the window period large enough for the HIV test that it could slip through that way, i.e. you get infected on Friday, die and organs get harvested/get tested on Monday (or possibly longer) but you have not been infected long enough for the test to detect it? I had to sign a waiver acknowledging this possibility when I had some dental procedure last year.
  - KeplerBoy 2y ago
    Sounds reasonable, but why would they have you sign that before having a dental procedure? Is it in case one of the doctors or nurses infects you?
    - denotational 2y ago
      Cadaver allografts (for dental bone implants) can transfer HIV.
- dyauspitr 2y ago
  It is but the test isn’t fully considered accurate for the first 30 days (45-90 days to be conclusive). That’s a long window of time for the virus to spread.
Havoc 2y ago
That’s rough cause transplants usually mean immunosuppressants which is precisely what you don’t want for hiv
- credit_guy 2y ago
  Why? If you have HIV you need to be on antiretroviral drugs. They keep your viral load to undetectable levels, so your immune system does not need to fight it.
  - spondylosaurus 2y ago
    Yep, if HIV progresses to the point of AIDS, suppressing your already-suppressed immune system would be bad. But with today's treatment regimens HIV won't progress anywhere near that point. Which is borderline miraculous, really. HIV is the virus that makes you develop (or "acquire") AIDS; AIDS is the condition that weakens and kills you. If you pump the breaks as soon as possible, HIV on its own won't have catastrophic health implications, although it's obviously better not to have it at all.
    - akira2501 2y ago
      > HIV on its own won't have catastrophic health implications Yes it does. You can never let your blood or sexual fluids come in contact with another uninfected person and you can also never be a mother. Your lifespan probably won't be impacted all that much. These are two wildly different things.
      - spondylosaurus 2y ago
        Not true at all! You can absolutely get pregnant with HIV, and there are a number of steps you can take to prevent transmission to an unborn child. Similarly, if you take antivirals to get your viral load down to undetectable levels, the risk of sexual transmission is very, very low. The risk is even lower if your partner takes PrEP as well. You certainly need to take precautions, but people with HIV can live full, normal lives.
tbrownaw 2y ago
> laboratory responsible for conducting tests on donated organs had been suspended after the organs from two donors were transplanted into six people So they missed the same thing twice, presumably at around the same time. > and all stored organs from donors are being tested back to December 2023 when the lab was hired I had the impression that there was a very short time limit, like maybe as long as a couple days. Is this just wrong, or does it only apply to same things?
flykespice 2y ago
Just for additional note: * the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho. * Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion they didn't do the tests at all and forged the results. * Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.
- Qem 2y ago
  [flagged]
  - appendix-rock 2y ago
    No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
    - iancmceachern 2y ago
      Yeah, it's more about the failure of the checks and balances in both cases. Old school corruption really.
    - zmgsabst 2y ago
      Okay — what makes it more complicated?
      - lukan 2y ago
        Because you can have solid outsourced work, as long as you bother to check and verify that work.
        zmgsabst 2y ago
anon291 2y ago
So dumb question, but if you have HIV, does that mean you won't have transplant rejection? Or are there two different mechanisms of immunity here?
- smileybarry 2y ago
  (Disclaimer: not a doctor) AIDS is the immune deficiency-causing virus, and that begins (usually) way after an HIV infection takes place — months, years. So until then, they’d still need to take immunosuppressants.
  - phoe-krk 2y ago
    > AIDS is the immune deficiency-causing virus AIDS (Acquired Immune Deficiency Syndrome) the illness, whereas a HIV infection (Human Immunodeficiency Virus) is its cause.
    - smileybarry 2y ago
      That's what I meant but I accidentally used the term virus, thanks.
  - iknowstuff 2y ago
    to be clear, I believe modern antiretrovirals can prevent the virus from replicating for an entire lifetime. They bring the viral load down to undetectable levels.
    - echelon 2y ago
      They're miracle drugs, but they aren't panaceas. Hopefully they are administered before too much damage to the immune system is done. And hopefully the treatment regimen is adhered to, because the virus can become resistant. It is so much better to not have the virus in the first place.
    - smileybarry 2y ago
      Oh of course, I just meant to emphasize that it isn't HIV that causes immune system deficiency, therefore, transplant rejection can still occur.
mlcruz 2y ago
A little bit more context: Rio de Janeiro is by far the most corrupt Brazilian state. Its hard to explain how bad it is if you are not Brazilian, but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended. So what usually happens is that someone from the public sector opens up a public bidding for some service to be done by the private sector, and usually who wins is someone who has ties with the local government. Most of the time whoever wins the bid (usually some shell company) is going to barely offer the service, and share most of the profits with their associates in the local gov. This is one of such cases: The private lab doing the tests is owned by the cousin of the former state secretary of health Dr.Luizinho. Its very likely that they just did not do the tests at all (yes, that how bad it is) Just another normal day in Rio de Janeiro.
- RcouF1uZ4gsC 2y ago
  > but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended Sounds similar to Illinois
  - unobatbayar 2y ago
    Similarly to the Mongolian government, except that only major cases are targeted, and instead of the actual culprits, people who were just doing their jobs under them end up in prison. Case closed.
- wslh 2y ago
  Interesting perspective on the impact of corruption across different countries. It's striking how two countries with similar levels of corruption can have vastly different outcomes in specific areas. Take Argentina as an example: while it's highly corrupt, organ transplants are remarkably well-organized under a single entity, INCUCAI [1]. You can even see crystal clear stats there. [1] https://www.argentina.gob.ar/salud/incucai https://www.argentina.gob.ar/salud/incucai
  - DanielHB 2y ago
microbugged 2y ago
[flagged]
milkcircle 2y ago
For those who watch medical shows, this is somewhat reminiscent of a case of several patients who contracted rabies through organ transplants - a story that was portrayed in Scrubs season 5 episode 20, "My Lunch".
dredmorbius 2y ago
Shades of the UK infected blood scandal of the 1970s -- 1990s: <https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_United_Kingdom https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_...>
- VeejayRampay 2y ago
  the same thing happened in the states and France among other countries, it was a global thing
  - dredmorbius 2y ago
    At the bottom of the Wikipedia article I'd linked are references to similar scandals in France as you note, Arkansas, Libya, Italy, and Scotland.
DoreenMichele 2y ago
Organ transplants are "ooh, shiny" headline grabbing medicine. Better healthcare to try to keep your original equipment is boring and gets dismissed as "just lucky." It's hard to prove a connection between x, y z and not needing a transplant. Any criticism or critique of this paradigm gets hated on without anyone really listening or wondering what might motivate someone to be not crazy about our "we are borg" trends in medical care.
- unwise-exe 2y ago
  >>> Any criticism or critique of this paradigm gets hated on without anyone really listening I'm having a hard time following this. Could you perhaps reference some examples to illustrate what you mean here?
- majormajor 2y ago
  Everyone I've ever talked to dealing with conditions that often end in transplant knows and shares that they're big-deal, serious-business, forever-life-altering treatments that are ultimate last resorts. But for some things we simply don't have any alternatives. And for some of those - for instance one of the super-obvious ones is alchoholism-induced cirrhosis - "don't drink so much that you kill your liver" is VERY discussed, not just considered "lucky." You might even get yourself disqualified from a transplant if you can't get it under control. Everyone would MUCH rather you not need it. Where are you seeing "get a transplant" pushed as a shiny panacea? They aren't even new anymore... lots of newer-shinies out there.
- kelnos 2y ago
  Sure, reducing the conditions that lead people to need transplants is a great idea, and should be done more. But I don't see how that's relevant to this discussion.
ggernov 2y ago
Maybe people with HIV just shouldn't donate blood or organs...
- DoreenMichele 2y ago
  It's possible they didn't know they were infected.
- magnetowasright 2y ago
  Oh my god, why didn't anyone think of that! Do you think people are doing it intentionally?
dyauspitr 2y ago
What happens if someone contracts HIV and dies over the next 2 weeks before the virus is detectable in tests. Would it propagate even in a dead body? Using an organ from this donor would cause HIV either ways and so is honestly a risk factor for US donors as well.
RecycledEle 2y ago
I wonder what HIV tests cost. Also, if I were dying of organ failure, getting (treatable) HIV to get a transplant might be a good deal. This is not 1988. HIV is treatable today. Note: There are 3 kinds of illness: curable, treatable, and terminal. Curable illnesses can (generally) be cured. Treatable illnesses will be with the patient for the rest of their life, but are treatable so the patient does not have to die from them. Terminal illnesses kill the patient.

186 points by flykespice 2y ago

the_real_cher 2y ago

Its just bizarre to me how simple this is to avoid. Its one of the most common place tests in the world.

wslh 2y ago
Yes, incredible. When HIV/AIDS emerged, dentists were among the first professionals to adopt protective measures. I don't have more details than what's mentioned in the article, but situations like this can sometimes reflect a deeper issue within the underlying professional and organizational structures, almost as if they're "calcifying", not just negligence, but a symptom of how things are functioning beneath the surface. On the other hand, it might simply be a case of individual malpractice, though I think the latter will be rare in the context of transplants.
- afh1 2y ago
  Rio isn't exactly known for its solid institutions or sanitary excellence.
stevenwoo 2y ago
Isn't the window period large enough for the HIV test that it could slip through that way, i.e. you get infected on Friday, die and organs get harvested/get tested on Monday (or possibly longer) but you have not been infected long enough for the test to detect it? I had to sign a waiver acknowledging this possibility when I had some dental procedure last year.
- KeplerBoy 2y ago
  Sounds reasonable, but why would they have you sign that before having a dental procedure? Is it in case one of the doctors or nurses infects you?
  - denotational 2y ago
    Cadaver allografts (for dental bone implants) can transfer HIV.
dyauspitr 2y ago
It is but the test isn’t fully considered accurate for the first 30 days (45-90 days to be conclusive). That’s a long window of time for the virus to spread.

Havoc 2y ago

That’s rough cause transplants usually mean immunosuppressants which is precisely what you don’t want for hiv

credit_guy 2y ago
Why? If you have HIV you need to be on antiretroviral drugs. They keep your viral load to undetectable levels, so your immune system does not need to fight it.
- spondylosaurus 2y ago
  Yep, if HIV progresses to the point of AIDS, suppressing your already-suppressed immune system would be bad. But with today's treatment regimens HIV won't progress anywhere near that point. Which is borderline miraculous, really. HIV is the virus that makes you develop (or "acquire") AIDS; AIDS is the condition that weakens and kills you. If you pump the breaks as soon as possible, HIV on its own won't have catastrophic health implications, although it's obviously better not to have it at all.
  - akira2501 2y ago
    > HIV on its own won't have catastrophic health implications Yes it does. You can never let your blood or sexual fluids come in contact with another uninfected person and you can also never be a mother. Your lifespan probably won't be impacted all that much. These are two wildly different things.
    - spondylosaurus 2y ago
      Not true at all! You can absolutely get pregnant with HIV, and there are a number of steps you can take to prevent transmission to an unborn child. Similarly, if you take antivirals to get your viral load down to undetectable levels, the risk of sexual transmission is very, very low. The risk is even lower if your partner takes PrEP as well. You certainly need to take precautions, but people with HIV can live full, normal lives.

tbrownaw 2y ago

> laboratory responsible for conducting tests on donated organs had been suspended after the organs from two donors were transplanted into six people So they missed the same thing twice, presumably at around the same time. > and all stored organs from donors are being tested back to December 2023 when the lab was hired I had the impression that there was a very short time limit, like maybe as long as a couple days. Is this just wrong, or does it only apply to same things?

flykespice 2y ago

Just for additional note: * the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho. * Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion they didn't do the tests at all and forged the results. * Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.

Qem 2y ago
[flagged]
- appendix-rock 2y ago
  No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
  - iancmceachern 2y ago
    Yeah, it's more about the failure of the checks and balances in both cases. Old school corruption really.
  - zmgsabst 2y ago
    Okay — what makes it more complicated?
    - lukan 2y ago
      Because you can have solid outsourced work, as long as you bother to check and verify that work.
      - zmgsabst 2y ago

anon291 2y ago

So dumb question, but if you have HIV, does that mean you won't have transplant rejection? Or are there two different mechanisms of immunity here?

smileybarry 2y ago
(Disclaimer: not a doctor) AIDS is the immune deficiency-causing virus, and that begins (usually) way after an HIV infection takes place — months, years. So until then, they’d still need to take immunosuppressants.
- phoe-krk 2y ago
  > AIDS is the immune deficiency-causing virus AIDS (Acquired Immune Deficiency Syndrome) the illness, whereas a HIV infection (Human Immunodeficiency Virus) is its cause.
  - smileybarry 2y ago
    That's what I meant but I accidentally used the term virus, thanks.
- iknowstuff 2y ago
  to be clear, I believe modern antiretrovirals can prevent the virus from replicating for an entire lifetime. They bring the viral load down to undetectable levels.
  - echelon 2y ago
    They're miracle drugs, but they aren't panaceas. Hopefully they are administered before too much damage to the immune system is done. And hopefully the treatment regimen is adhered to, because the virus can become resistant. It is so much better to not have the virus in the first place.
  - smileybarry 2y ago
    Oh of course, I just meant to emphasize that it isn't HIV that causes immune system deficiency, therefore, transplant rejection can still occur.

mlcruz 2y ago

A little bit more context: Rio de Janeiro is by far the most corrupt Brazilian state. Its hard to explain how bad it is if you are not Brazilian, but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended. So what usually happens is that someone from the public sector opens up a public bidding for some service to be done by the private sector, and usually who wins is someone who has ties with the local government. Most of the time whoever wins the bid (usually some shell company) is going to barely offer the service, and share most of the profits with their associates in the local gov. This is one of such cases: The private lab doing the tests is owned by the cousin of the former state secretary of health Dr.Luizinho. Its very likely that they just did not do the tests at all (yes, that how bad it is) Just another normal day in Rio de Janeiro.

RcouF1uZ4gsC 2y ago
> but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended Sounds similar to Illinois
- unobatbayar 2y ago
  Similarly to the Mongolian government, except that only major cases are targeted, and instead of the actual culprits, people who were just doing their jobs under them end up in prison. Case closed.
wslh 2y ago
Interesting perspective on the impact of corruption across different countries. It's striking how two countries with similar levels of corruption can have vastly different outcomes in specific areas. Take Argentina as an example: while it's highly corrupt, organ transplants are remarkably well-organized under a single entity, INCUCAI [1]. You can even see crystal clear stats there. [1] https://www.argentina.gob.ar/salud/incucai https://www.argentina.gob.ar/salud/incucai
- DanielHB 2y ago

microbugged 2y ago

[flagged]

milkcircle 2y ago

For those who watch medical shows, this is somewhat reminiscent of a case of several patients who contracted rabies through organ transplants - a story that was portrayed in Scrubs season 5 episode 20, "My Lunch".

dredmorbius 2y ago

Shades of the UK infected blood scandal of the 1970s -- 1990s: <https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_United_Kingdom https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_...>

VeejayRampay 2y ago
the same thing happened in the states and France among other countries, it was a global thing
- dredmorbius 2y ago
  At the bottom of the Wikipedia article I'd linked are references to similar scandals in France as you note, Arkansas, Libya, Italy, and Scotland.

DoreenMichele 2y ago

Organ transplants are "ooh, shiny" headline grabbing medicine. Better healthcare to try to keep your original equipment is boring and gets dismissed as "just lucky." It's hard to prove a connection between x, y z and not needing a transplant. Any criticism or critique of this paradigm gets hated on without anyone really listening or wondering what might motivate someone to be not crazy about our "we are borg" trends in medical care.

unwise-exe 2y ago
>>> Any criticism or critique of this paradigm gets hated on without anyone really listening I'm having a hard time following this. Could you perhaps reference some examples to illustrate what you mean here?
majormajor 2y ago
Everyone I've ever talked to dealing with conditions that often end in transplant knows and shares that they're big-deal, serious-business, forever-life-altering treatments that are ultimate last resorts. But for some things we simply don't have any alternatives. And for some of those - for instance one of the super-obvious ones is alchoholism-induced cirrhosis - "don't drink so much that you kill your liver" is VERY discussed, not just considered "lucky." You might even get yourself disqualified from a transplant if you can't get it under control. Everyone would MUCH rather you not need it. Where are you seeing "get a transplant" pushed as a shiny panacea? They aren't even new anymore... lots of newer-shinies out there.
kelnos 2y ago
Sure, reducing the conditions that lead people to need transplants is a great idea, and should be done more. But I don't see how that's relevant to this discussion.

ggernov 2y ago

Maybe people with HIV just shouldn't donate blood or organs...

DoreenMichele 2y ago
It's possible they didn't know they were infected.
magnetowasright 2y ago
Oh my god, why didn't anyone think of that! Do you think people are doing it intentionally?

dyauspitr 2y ago

What happens if someone contracts HIV and dies over the next 2 weeks before the virus is detectable in tests. Would it propagate even in a dead body? Using an organ from this donor would cause HIV either ways and so is honestly a risk factor for US donors as well.

RecycledEle 2y ago

I wonder what HIV tests cost. Also, if I were dying of organ failure, getting (treatable) HIV to get a transplant might be a good deal. This is not 1988. HIV is treatable today. Note: There are 3 kinds of illness: curable, treatable, and terminal. Curable illnesses can (generally) be cured. Treatable illnesses will be with the patient for the rest of their life, but are treatable so the patient does not have to die from them. Terminal illnesses kill the patient.