Six transplant patients in Brazil contract HIV from infected organs | Hacker News Reader

Six transplant patients in Brazil contract HIV from infected organs

reuters.com

186 pointsflykespice104 comments

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.

> Dr.Luizinho.

He was also short listed to take over the Ministry of Health under Bolsonaro’s government.

Shades of the UK infected blood scandal of the 1970s -- 1990s:

<https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_...>

the same thing happened in the states and France among other countries, it was a global thing

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.

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

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.

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.

> 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.

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.

Normal lives is not exactly the correct term. Like any drugs, HIV medication come with their own bagage of side effects.

Let's say people with HIV can live like most people receiving treatment for a chronic disease.

The rest of your points stands.

That may have been true decades ago, but is no longer the case. Of course nothing is risk-free, but current drugs can get HIV viral loads down to undetectable levels, and if your drug treatment is successful, it's considered reasonably safe for you to swap fluids with others (with their knowledge of your medical history, and consent, of course), as well as become pregnant. Sexual partners should be on PrEP too, to further reduce the risk.

This isn't "living a normal life" completely, and the retrovirals have side effects and the regimen needs to be maintained, but the state of things for people with HIV is so much better than it was back in the 90s.

I don’t know why you are getting downvoted but I’m guessing that a lot of people don’t know about/understand that undetectable = untransmittable. It is generally seen as safe to have unprotected sex with someone whose viral load is suppressed to the point of being undetectable. Of course you need to believe that’s the case, informed consent is still important, and it’s probably a good idea for the negative party to be on prep, but the fact that the likelihood of transmission is so low if someone is undetectable is widely accepted in medicine and widely known in the LGBTQ+ community at this point.

Just because your condition has catastrophic consequences, particularly if not _properly_ managed, doesn't mean you have to live your life in a catastrophic way.

Pretending that should be ignored benefits no one.

Not quite, the proper course of action is that both you AND your partner take drugs to prevent transmission

Antiretrovirals have significant risks and adverse effects. Uninfected people don't take antiretrovirals unless they have been exposed to the virus. They protect against exposure instead.

The chance of both condoms and antiretroviral therapy failing to prevent transmission simultaneously is always going to be lower than the chance of either failing independently. In practice, many couples decide that the risk of transmission associated with antiretroviral therapy is low enough for them.

Yes you’re right. I was wrong. I confused it with the case where you both have HIV since they can be different strains.

> You can never let your blood or sexual fluids come in contact with another uninfected person and you can also never be a mother.

Completely false. Treatment is quite effective at preventing transmission in both cases.

The drugs have lifelong costs and side effects, and patients have lower life expectancy than the general population.

Massive improvement to what came before but it's still much worse than most health outcomes people take pains to avoid.

https://www.webmd.com/hiv-aids/aids-hiv-medication-side-effe...

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?

(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.

> AIDS is the immune deficiency-causing virus

AIDS (Acquired Immune Deficiency Syndrome) the illness, whereas a HIV infection (Human Immunodeficiency Virus) is its cause.

That's what I meant but I accidentally used the term virus, thanks.

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.

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.

Oh of course, I just meant to emphasize that it isn't HIV that causes immune system deficiency, therefore, transplant rejection can still occur.

But after AIDS sets in, you don't?

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.

> 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

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.

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

Corruption is not a single axis, for example college entrance exams and voting in brazil are very trustworthy in my opinion.

Institutions are corrupt, not a whole country. Sure there is some level of infection between institutions but there is still a lot of a single one can do.

One thing you don't see in Brazil is traffic police or bureaucrats asking for petty bribes, something which is quite common in neighbouring countries.

Corruption is a problem for sure, but I think incompetence and lack of initiative are far worse issues in the Brazilian executive.

> voting in brazil are very trustworthy

How can a closed system that cannot be audited be considered trustworthy? After the voting happens, there's no physical proof of the vote.

Highly recommend reading this: https://dfaranha.github.io/project/evoting/

Because the supreme court judge has decreed that the voting machines are UNQUESTIONABLE. That's all there is to it. Not even our elected representatives get to doubt these things:

https://news.ycombinator.com/item?id=36543423

Fun fact: brazilians commonly express feelings of superiority towards civilized developed world nations because of these voting machines. They think americans, germans and everyone else in the world are living in the literal stone age due to their "archaic" voting processes just because it takes time to count the votes.

Brazil is way more decentralized in that way, especially health care, so health care quality will greatly change depending on your city even.

That said, organ transplants in Brazil are managed by the Federal Government (lists, etc), but the clinics and hospitals will usually be state or city made...

Brazil is pretty good at organ transplants, surprisingly.

I usually direct people to watch the movies Elite Squad 1 and 2. They're entertaining and pretty much explain why Rio is so violent and so corrupt and how both things feed off each other.

Incredible movie. And, the backstory is incredible as well: https://en.wikipedia.org/wiki/Elite_Squad

I'd like to note that Brazil is not at all unique in being corrupt or even in the methods used. For example, watch HBO's The Wire and you'll find the police and politicians playing the exact same numbers game. It seems to be inherent to democracy, a side effect of reelection.

The films do a wondeful job depicting the poverty of Brazil, and the way it attracts people to organized crime. It attracts so many of them, they form a nation unto themselves. Complete with their own army, territory, laws, tribunals... It gets to the point it's a silent secession.

Not uniquely corrupt but uniquely violent (before the Ukraine invasion one in eight violent homicides happened in Brazil... not South America, Brazil).

Besides, I don't know great movies that explain the corruption and violence on each metropolis, just this one (and The Wire for Baltimore, which is by the way great television).

I'd recommend also watching the Vice piece on how Brazilian gangs are fueling violence in Paraguay. It's quite jarring to see the slang of street criminals of Rio and SP spoken across the border in what is a war like situation.

How free do people feel to speak up against corruption? Like could they go public on Twitter/X and call out the issues they see? Or would they face legal retribution or physical violence?

Freedom of expression is guaranteed in Brazil. In general people feel free to speak and that hasn't changed.

What has become a crime is the spread of misinformation in the form of fake news. For the most part these are still legislated fairly IMHO. But the precedent feels a bit dangerous

There are zero laws against "fake news" currently in effect in Brazil. One was proposed and Google even campaigned against it but it has yet to pass.

It really depends. Locally, factions like criminal associations and retired cops mafias (militias), who always have city councelors and mayors in their pockets, may retaliate if someone with an audience is being too annoying (see Marielle Franco's case).

Nationally, not all politicians enjoy any protection from the supreme court against critiscism, only the best connected ones and the supreme court itself. Recently, a former YouTuber who lost all his social accounts and had to self-exile to the US for some disrespectful comments against the supreme court was sentenced to 1.5 years in jail for calling the newest supreme court judge a "fatty".

Except for the supreme court itself, the average Brazilian can voice their concerns and speak up against corruption with very low chances of repercussions if they don't display wholly anti-democratic discourse, like wishing the military to execute a coup.

> a former YouTuber

Remember he also committed the crime, live, on YouTube, of advocating for the creation of a Nazi party.

Thought crime, huh.

He merely observed that the extreme left has a lot more space in politics than the extreme right. Why is it that nazism is banned while we have so many literal proud self-admitted socialists and communists in this country who not only walk this soil completely unpunished but also form organized parties, get elected, get appointed to the supreme court? The judge who held him guilty for calling him a "fatty" is the perfect example of one.

Anti-nazism laws are unconstitutional. Constitution says that "any and all" censorship of political nature is prohibited. Nazism is a political party. Therefore censorship of nazism is prohibited. It's that simple.

So why is it that nazism is literal thought crime while socialism and communism, far more harmful ideologies, are allowed to flourish with complete impunity? If they're gonna ban nazis, I demand that they also ban communists and socialists. It should be a literal thought crime to advocate for anything related to that nonsense. And any form of socialist organization should get all involved sent straight to jail.

That's the point that was made. Allowing that crap while simultaneously banning nazism is a contradiction. His only "crime" here was trying to resolve the contradiction by arguing that nazis should be allowed to organize. That's not what we really want. What we actually want is these socialists and communists in jail.

> Anti-nazism laws are unconstitutional. Constitution says that "any and all" censorship of political nature is prohibited. Nazism is a political party. Therefore censorship of nazism is prohibited. It's that simple.

There’s no censorship. You are allowed to say your mind and nobody can prevent you from doing it. Freedom to do something doesn’t imply impunity for committing crimes in the process of expressing your political beliefs.

> the extreme left

Brazil had a far-right president for four years. There’s zero far-left in mainstream politics in Brazil, unless you slide the Overton window so far to the right social democrats (such as PT) looks far-left and Bolsonaro looks like a moderate right-winger.

> There’s no censorship.

> Freedom to do something doesn’t imply impunity for committing crimes in the process of expressing your political beliefs.

Those two statements contradict each other. One can't criminalize political beliefs and simultaneously claim that there is no censorship of political beliefs.

The man had his social media presence blocked for his wrongthink. That is censorship.

> There’s zero far-left in mainstream politics in Brazil

There must be dozens of political parties with communism and socialism right in the name. Not social-democracy, not social-anything. Straight up socialist and communist parties. Why is this allowed?

And it's not just the names either, as is often claimed. They are very much socialists in their proposals and public policies. Why are these ideas allowed to spread and proliferate?

> Those two statements contradict each other.

No. Censorship is preventing you from saying something. Arresting you for committing a crime is not censorship. Germany is a democracy where you’ll land in jail for defending the creation of a nazi party. Is that censorship?

> with communism and socialism right in the name.

Is anyone actually proposing the abolition of private property and the seizure of the means of production by the proletariat?

> Censorship is preventing you from saying something.

That's exactly what happened. His channel was blocked by order of a judge. Censorship.

> Arresting you for committing a crime is not censorship.

Criminalizing any form of political idea absolutely is political censorship. The whole purpose of heavily punishing crimes is to prevent said crimes from occurring. Punishing certain political positions is therefore equivalent to preventing said political positions from being expressed.

If we're gonna stoop to this tyranny, then I'm gonna start enumerating a whole slew of equally harmful or even worse ideas for the tyrant's perusal. Let's start with the complete erasure of socialism and communism and everything related to it, and the incarceration of every single subversive person involved with it.

Why censor nazis but not these communists? Makes absolutely no sense. If they censor nazis but refuse to censor these socialists whose dictatorial regimes have genocided their own populations, I'm gonna start drawing some very uncomfortable conclusions about the way the world works.

> Germany is a democracy where you’ll land in jail for defending the creation of a nazi party. Is that censorship?

I'm sure everybody feels righteous about banning nazis. The problem is that banning nazis is unconstitutional here in Brazil. Nazis are just a political party, the national-socialist worker's party, ironically. And in Brazil, any and all forms of political censorship is prohibited.

I have no idea what the german constitution says. Maybe it is constitutional there.

From a moral standpoint, though, I see no reason to believe it's not censorship. Plenty of consumer media depicting nazism needs to be "adapted" in order to be published in Germany. That's China tier protection against harmful ideas as far as I'm concerned. I certainly consider it to be censorship. I have no idea whether german law considers it so.

> Is anyone actually proposing the abolition of private property and the seizure of the means of production by the proletariat?

Lula has literally recorded himself saying the state should seize people's inheritances and then determine "what people need to survive" so that it can give them exactly that.

These guys are socialists and communists, there is absolutely no doubt about it. I have no idea why I have to prove this every single time. They're pretty proud of being what they are.

About the "fatty" one... This is more how richer/powerful people have more resources to sue. The case would be a clearly win for everyone who sue it.

Brazil's penal code criminalize any "Injury" and "defemation"

> Art. 139 - To defame someone, attributing to them a fact that is offensive to their reputation:

> Penalty - detention from three months to one year, and a fine.

> Art. 140 - To insult someone, offending their dignity or decency:

> Penalty - detention from one to six months, or a fine.

See the recent spat between the Brazilian supreme court and Twitter for your answer there

> Its hard to explain how bad it is if you are not Brazilian

It's hard to explain to most Brazilians too.

People go there expecting the worst. I don't think I've met anyone that wasn't still surprised.

Huh, as a South African, now I'm quite intrigued to visit it.

Tangentially related, but when i lived in Rio I would always tell people I thought it was the most beautiful city in the world. Then, a visiting exec asked me: "Well, have you been to Cape Town?"

As a tourist you won't get yourself in situations like people throwing threats at you because you obeyed traffic laws.

Rio de Janeiro is corrupt, but it is far from the most corrupt in relative terms. Contrary to popular perception is not even one of the most violent.

Its just bizarre to me how simple this is to avoid.

Its one of the most common place tests in the world.

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.

Rio isn't exactly known for its solid institutions or sanitary excellence.

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.

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?

Cadaver allografts (for dental bone implants) can transfer HIV.

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.

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.

>>> 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?

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.

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.

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.

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.

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

It's possible they didn't know they were infected.

Oh my god, why didn't anyone think of that!

Do you think people are doing it intentionally?

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".

> 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?

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