National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States
William A Werbel, Diane M Brown, Oyinkansola T Kusemiju, Brianna L Doby, Shanti M Seaman, Andrew D Redd, Yolanda Eby, Reinaldo E Fernandez, Niraj M Desai, Jernelle Miller, Gilad A Bismut, Charles S Kirby, Haley A Schmidt, William A Clarke, Michael Seisa, Christos J Petropoulos, Thomas C Quinn, Sander S Florman, Shirish Huprikar, Meenakshi M Rana, Rachel J Friedman-Moraco, Aneesh K Mehta, Peter G Stock, Jennifer C Price, Valentina Stosor, Shikha G Mehta, Alexander J Gilbert, Nahel Elias, Michele I Morris, Sapna A Mehta, Catherine B Small, Ghady Haidar, Maricar Malinis, Jennifer S Husson, Marcus R Pereira, Gaurav Gupta, Jonathan Hand, Varvara A Kirchner, Avinash Agarwal, Saima Aslam, Emily A Blumberg, Cameron R Wolfe, Kevin Myer, R Patrick Wood, Nikole Neidlinger, Sara Strell, Marion Shuck, Harry Wilkins, Matthew Wadsworth, Jennifer D Motter, Jonah Odim, Dorry L Segev, Christine M Durand, Aaron A R Tobian, HOPE in Action Investigators, Dominque Piquant, Katherine Link, Marion Hemmersbach-Miller, Thomas Pearson, Nicole Turgeon, G Marshall Lyon, William Kitchens, Jeryl Huckaby, A Francie Lasseter, Rivka Elbein, April Roberson, Elizabeth Ferry, Ethan Klock, Willa V Cochran, Michelle Morrison, Sarah Rasmussen, Juli Bollinger, Jeremy Sugarman, Angela R Smith, Margaret Thomas, Margaret Coakley, Joseph Timpone, Alyssa Stucke, Brandy Haydel, Rebecca Dieter, Elizabeth J Klein, Henry Neumann, Lorenzo Gallon, Leah Goudy, Michelle Callegari, Ilise Marrazzo, Towanda Jackson, Timothy Pruett, Mary Farnsworth, Jayme E Locke, Darnell Mompoint-Williams, Katherine Basinger, Kristin Mekeel, Phirum Nguyen, Joanne Kwan, Tab Srisengfa, Peter Chin-Hong, Rodney Rogers, Jacques Simkins, Carlos Munoz, Ty Dunn, Dierdre Sawinski, Fernanda Silveira, Kailey Hughes, Diana Lynn Pakstis, Jamie Nagy, Mary Baldecchi, Thangamani Muthukumar, Melissa D Eddie, Katharine Robb, Elizabeth Salsgiver, Britta Witting, Marwan M Azar, Merceditas Villanueva, Richard Formica, Ricarda Tomlin, William A Werbel, Diane M Brown, Oyinkansola T Kusemiju, Brianna L Doby, Shanti M Seaman, Andrew D Redd, Yolanda Eby, Reinaldo E Fernandez, Niraj M Desai, Jernelle Miller, Gilad A Bismut, Charles S Kirby, Haley A Schmidt, William A Clarke, Michael Seisa, Christos J Petropoulos, Thomas C Quinn, Sander S Florman, Shirish Huprikar, Meenakshi M Rana, Rachel J Friedman-Moraco, Aneesh K Mehta, Peter G Stock, Jennifer C Price, Valentina Stosor, Shikha G Mehta, Alexander J Gilbert, Nahel Elias, Michele I Morris, Sapna A Mehta, Catherine B Small, Ghady Haidar, Maricar Malinis, Jennifer S Husson, Marcus R Pereira, Gaurav Gupta, Jonathan Hand, Varvara A Kirchner, Avinash Agarwal, Saima Aslam, Emily A Blumberg, Cameron R Wolfe, Kevin Myer, R Patrick Wood, Nikole Neidlinger, Sara Strell, Marion Shuck, Harry Wilkins, Matthew Wadsworth, Jennifer D Motter, Jonah Odim, Dorry L Segev, Christine M Durand, Aaron A R Tobian, HOPE in Action Investigators, Dominque Piquant, Katherine Link, Marion Hemmersbach-Miller, Thomas Pearson, Nicole Turgeon, G Marshall Lyon, William Kitchens, Jeryl Huckaby, A Francie Lasseter, Rivka Elbein, April Roberson, Elizabeth Ferry, Ethan Klock, Willa V Cochran, Michelle Morrison, Sarah Rasmussen, Juli Bollinger, Jeremy Sugarman, Angela R Smith, Margaret Thomas, Margaret Coakley, Joseph Timpone, Alyssa Stucke, Brandy Haydel, Rebecca Dieter, Elizabeth J Klein, Henry Neumann, Lorenzo Gallon, Leah Goudy, Michelle Callegari, Ilise Marrazzo, Towanda Jackson, Timothy Pruett, Mary Farnsworth, Jayme E Locke, Darnell Mompoint-Williams, Katherine Basinger, Kristin Mekeel, Phirum Nguyen, Joanne Kwan, Tab Srisengfa, Peter Chin-Hong, Rodney Rogers, Jacques Simkins, Carlos Munoz, Ty Dunn, Dierdre Sawinski, Fernanda Silveira, Kailey Hughes, Diana Lynn Pakstis, Jamie Nagy, Mary Baldecchi, Thangamani Muthukumar, Melissa D Eddie, Katharine Robb, Elizabeth Salsgiver, Britta Witting, Marwan M Azar, Merceditas Villanueva, Richard Formica, Ricarda Tomlin
Abstract
Background: Organ transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety.
Methods: We performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors.
Results: Between March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL <400 copies/mL. The median CD4 T-cell count (interquartile range) was 194/µL (77-331/µL), and the median CD4 T-cell percentage was 27.0% (16.8%-36.1%). Major HIV DRMs were detected in 42%, including nonnucleoside reverse-transcriptase inhibitors (33%), integrase strand transfer inhibitors (4%), and multiclass (13%). Serum ART was detected in 46% and matched ART by history.
Conclusion: The use of HIV-positive donor organs is increasing. HIV DRMs are common, yet resistance that would compromise integrase strand transfer inhibitor-based regimens is rare, which is reassuring regarding safety.
Keywords: HIV; drug resistance; organ donation; transplant.
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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Source: PubMed