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National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States CLINICAL INFECTIOUS DISEASES Werbel, W. A., Brown, D. M., Kusemiju, O. T., Doby, B. L., Seaman, S. M., Redd, A. D., Eby, Y., Fernandez, R. E., Desai, N. M., Miller, J., Bismut, G. A., Kirby, C. S., Schmidt, H. A., Clarke, W. A., Seisa, M., Petropoulos, C. J., Quinn, T. C., Florman, S. S., Huprikar, S., Rana, M. M., Friedman-Moraco, R. J., Mehta, A. K., Stock, P. G., Price, J. C., Stosor, V., Mehta, S. G., Gilbert, A. J., Elias, N., Morris, M., Mehta, S. A., Small, C. B., Haidar, G., Malinis, M., Husson, J. S., Pereira, M. R., Gupta, G., Hand, J., Kirchner, V. A., Agarwal, A., Aslam, S., Blumberg, E. A., Wolfe, C. R., Myer, K., Wood, R., Neidlinger, N., Strell, S., Shuck, M., Wilkins, H., Wadsworth, M., Motter, J. D., Odim, J., Segev, D. L., Durand, C. M., Tobian, A. R., HOPE Action Investigators 2021

Abstract

Organ transplantation from donors with HIV to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV+ donors is critical for safety.We performed a prospective study of donors with HIV-positive and HIV false-positive (FP) testing within the HOPE in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262; NCT03500315; NCT03734393). We compared clinical characteristics in HIV+ versus FP donors. We measured CD4+ T cells, HIV viral load (VL), drug resistance mutations (DRMs), co-receptor tropism, and serum antiretroviral therapy (ART) detection using mass spectrometry in HIV+ donors.Between 03/2016-03/2020, 92 donors (58 HIV+, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidney, 46 liver). Each year the number of donors increased. Prevalence of hepatitis B (16% vs. 0%), syphilis (16% vs. 0%), and cytomegalovirus (91% vs. 58%) was higher in HIV+ versus FP donors; hepatitis C viremia was similar (2% vs. 6%). Most HIV+ donors (71%) had known HIV diagnosis, of whom 90% were prescribed ART and 68% had VL<400 copies/mL. Median CD4 count was 194 cells/uL (IQR=77-331); median CD4% was 27.0 (IQR=16.8-36.1). Major HIV DRMs were detected in 42%, including non-nucleoside reverse transcriptase inhibitors (33%), integrase strand transfer inhibitor (INSTI, 4%), and multiclass (13%). Serum ART was detected in 46% and matched ART by history.Utilization of HIV+ donor organs is increasing. HIV DRMs are common, yet resistance that would compromise INSTI-based regimens is rare, which is reassuring regarding safety.

View details for DOI 10.1093/cid/ciab743

View details for Web of Science ID 000756574300001

View details for PubMedID 34453519