[HN Gopher] Six transplant patients in Brazil contract HIV from ...
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Six transplant patients in Brazil contract HIV from infected organs
Author : flykespice
Score : 139 points
Date : 2024-10-12 13:05 UTC (9 hours ago)
(HTM) web link (www.reuters.com)
(TXT) w3m dump (www.reuters.com)
| the_real_cher wrote:
| Its just bizarre to me how simple this is to avoid.
|
| Its one of the most common place tests in the world.
| wslh wrote:
| 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 wrote:
| Rio isn't exactly known for its solid institutions or
| sanitary excellence.
| stevenwoo wrote:
| 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 wrote:
| 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 wrote:
| Cadaver allografts (for dental bone implants) can transfer
| HIV.
| dyauspitr wrote:
| 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 wrote:
| That's rough cause transplants usually mean immunosuppressants
| which is precisely what you don't want for hiv
| credit_guy wrote:
| 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 wrote:
| 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 wrote:
| > 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 wrote:
| 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.
| prmoustache wrote:
| 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.
| tbrownaw wrote:
| > _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 wrote:
| 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 wrote:
| > Since many hospitals outsourced donor organ tests to the 3rd
| party lab
|
| It's the same sort of rampant outsourcing that doomed Boeing.
| This time instead of screwing passengers it screwed patients.
| appendix-rock wrote:
| 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 wrote:
| Yeah, it's more about the failure of the checks and
| balances in both cases. Old school corruption really.
| zmgsabst wrote:
| Okay -- what makes it more complicated?
| lukan wrote:
| Because you can have solid outsourced work, as long as
| you bother to check and verify that work.
| zmgsabst wrote:
| I haven't seen a company outsource a core competency and
| succeed, eg Boeing outsourcing airplane manufacturing.
| krisoft wrote:
| How about Apple and Foxconn?
|
| If your reaction is that Apple's core competency is in
| marketing and design and not manufacturing then i will
| ask if the same pattern couldn't be applied to Boeing.
| raziel2701 wrote:
| In this particular case you're saying you need to test
| the organs once at the outsource place and then again at
| the hospital? Why not just get rid of outsourcing then?
| Bouncingsoul1 wrote:
| No, that is not what the parent said. "Check an verfiy"
| can come in diffrent forms and tastes eg. having some
| samples (not all) checked by another lab, asking for
| standards and inspection performed by 3rd parties, asking
| and checking for documentation...the hell how do you
| think anybody could work with suppliers?
| krisoft wrote:
| > eg. having some samples (not all) checked by another
| lab,
|
| I don't think that is useful at all in case of rare
| diseases. You would just get two reports saying that the
| random sample is free of HIV.
|
| Much better would be to send some known control samples.
| Making sure that some of the samples is known HIV+, and
| then check if the supplier can tell which ones are those.
| JumpCrisscross wrote:
| > _Why not just get rid of outsourcing then?_
|
| The problem is corruption. I don't see why you think that
| wouldn't plague internal operations.
| braza wrote:
| Further context: In Brazil since we have universal health
| care provided by the government, generally speaking non
| outsourced or contractors becomes public servants.
|
| The issue is: Public service in Brazil is expensive and
| is virtually impossible to fire anyone. On top of that
| the cost of public service has second order effects in
| the public balance sheet for the municipalities plus it
| has a huge burden in the public retirement system.
|
| Not saying that is right or wrong, but this is very
| common in the Brazilian heath system.
| photochemsyn wrote:
| Nothing wrong with outsourcing as long as it doesn't allow
| the user of the third-party operation to escape legal
| liability for failures and fraud committed by said third
| party that affect the user's clients.
| JoshTko wrote:
| Outsourcing isn't a problem, people don't make their own
| clothes. It's inadequate checks relative to the risk of the
| component.
| raziel2701 wrote:
| How are you gonna check the organs? You can't see HIV on
| the organs by eye. Checking means re-testing, so might as
| well get rid of outsourcing.
| krisoft wrote:
| > How are you gonna check the organs?
|
| You don't check the organs. You check the process by
| intermingling known HIV+ samples and check if they are
| being detected.
|
| > Checking means re-testing, so might as well get rid of
| outsourcing.
|
| Thing is you need to do QA on the testing system no
| matter what. Doesn't matter if it is performed by
| contractors, in house staff or little grey aliens. If you
| are not doing QA you won't know if the testing is done
| correctly or not.
| rbanffy wrote:
| > Dr.Luizinho.
|
| He was also short listed to take over the Ministry of Health
| under Bolsonaro's government.
| anon291 wrote:
| 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 wrote:
| (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 wrote:
| _> 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 wrote:
| That's what I meant but I accidentally used the term virus,
| thanks.
| iknowstuff wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| > 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 wrote:
| 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 wrote:
| 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
| DanielHB wrote:
| 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.
| forinti wrote:
| 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.
| tarruda wrote:
| > 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/
| namaria wrote:
| 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.
| blackeyeblitzar wrote:
| 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?
| dudus wrote:
| 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
| luizcdc wrote:
| 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.
| HideousKojima wrote:
| See the recent spat between the Brazilian supreme court and
| Twitter for your answer there
| marcosdumay wrote:
| > 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.
| Synaesthesia wrote:
| Huh, as a South African, now I'm quite intrigued to visit it.
| elzbardico wrote:
| 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.
| milkcircle wrote:
| 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 wrote:
| Shades of the UK infected blood scandal of the 1970s -- 1990s:
|
| <https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_...>
| VeejayRampay wrote:
| the same thing happened in the states and France among other
| countries, it was a global thing
| dredmorbius wrote:
| 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 wrote:
| 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.
| ggernov wrote:
| Maybe people with HIV just shouldn't donate blood or organs...
| DoreenMichele wrote:
| It's possible they didn't know they were infected.
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