National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.

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.

• Authors: 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
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 74 Issue 11 Pg. 2010-2019 (06 10 2022) ISSN: 1537-6591 [Electronic] United States
• PMID: 34453519 (Publication Type: Journal Article, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Anti-Retroviral Agents
• Integrases

Topics

• Anti-Retroviral Agents (therapeutic use)
• HIV
• HIV Infections (drug therapy, epidemiology)
• HIV Seropositivity (drug therapy)
• Humans
• Integrases
• Prospective Studies
• Tissue Donors
• United States (epidemiology)
• Viral Load