Faced with the only chance to save a child's life, doctors in South Africa have performed a medical first - transplanting part of the liver from a HIV-positive mother into her HIV-negative child.
The doctors at the University of Witwatersrand in Johannesburg revealed that one year after the operation, the child may not have caught the virus from her new liver.
The child had a terminal liver disease and would have died without the transplant.
Medication given to the child "may have prevented the transmission of HIV. However, we will only know this conclusively over time," said Jean Botha, chief surgeon at the university.
The team of doctors at the Wits Donald Gordon Medical Centre performed what it said was the first liver transplant from a mother living with HIV to her HIV-negative child, who was close to death after waiting six months for a donor.
They said that the mother and child, who have not been identified, have fully recovered and are in good health. After transplants, liver remaining in the donor is able to regenerate rapidly.
The mother, who is being successfully treated with antiretroviral (ART) medication, had repeatedly asked to donate her liver to save her child's life, posing a major ethnical debate for doctors due to the risk of HIV transmission.
"The transplant team faced the dilemma of saving the child's life whilst at the same time knowing that the child might end up HIV positive," the university added. "The actual chance of transmitting HIV was unknown."
South Africa has the world's largest HIV treatment programme with 7.1 million people living with HIV, a 18.9% adult prevalence rate.
About 3.7 million people in the country receive treatment for HIV, so the use of HIV-positive donors could help tackle the severe shortage of donors.
In 2017, 14 children waiting for liver transplants in Johannesburg died before having the operation.
"We hope that this ground-breaking operation will be the first of many like it and will contribute towards promoting justice and equity in liver transplantation," said June Fabian, research director at the university's medical centre.
A paper detailing the case was published in the peer-reviewed AIDS medical journal.