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

Publication ,  Journal Article
Werbel, WA; Brown, DM; Kusemiju, OT; Doby, BL; Seaman, SM; Redd, AD; Eby, Y; Fernandez, RE; Desai, NM; Miller, J; Bismut, GA; Kirby, CS ...
Published in: Clin Infect Dis
June 10, 2022

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.

Duke Scholars

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

June 10, 2022

Volume

74

Issue

11

Start / End Page

2010 / 2019

Location

United States

Related Subject Headings

  • Viral Load
  • United States
  • Tissue Donors
  • Prospective Studies
  • Microbiology
  • Integrases
  • Humans
  • HIV Seropositivity
  • HIV Infections
  • HIV
 

Citation

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MLA
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Werbel, W. A., Brown, D. M., Kusemiju, O. T., Doby, B. L., Seaman, S. M., Redd, A. D., … HOPE in Action Investigators, . (2022). National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States. Clin Infect Dis, 74(11), 2010–2019. https://doi.org/10.1093/cid/ciab743
Werbel, William A., Diane M. Brown, Oyinkansola T. Kusemiju, Brianna L. Doby, Shanti M. Seaman, Andrew D. Redd, Yolanda Eby, et al. “National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.Clin Infect Dis 74, no. 11 (June 10, 2022): 2010–19. https://doi.org/10.1093/cid/ciab743.
Werbel WA, Brown DM, Kusemiju OT, Doby BL, Seaman SM, Redd AD, et al. National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States. Clin Infect Dis. 2022 Jun 10;74(11):2010–9.
Werbel, William A., et al. “National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.Clin Infect Dis, vol. 74, no. 11, June 2022, pp. 2010–19. Pubmed, doi:10.1093/cid/ciab743.
Werbel WA, Brown DM, Kusemiju OT, Doby BL, Seaman SM, Redd AD, Eby Y, Fernandez RE, Desai NM, Miller J, Bismut GA, Kirby CS, Schmidt HA, Clarke WA, Seisa M, Petropoulos CJ, Quinn TC, Florman SS, Huprikar S, Rana MM, Friedman-Moraco RJ, Mehta AK, Stock PG, Price JC, Stosor V, Mehta SG, Gilbert AJ, Elias N, Morris MI, Mehta SA, Small CB, Haidar G, Malinis M, Husson JS, Pereira MR, Gupta G, Hand J, Kirchner VA, Agarwal A, Aslam S, Blumberg EA, Wolfe CR, Myer K, Wood RP, Neidlinger N, Strell S, Shuck M, Wilkins H, Wadsworth M, Motter JD, Odim J, Segev DL, Durand CM, Tobian AAR, HOPE in Action Investigators. National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States. Clin Infect Dis. 2022 Jun 10;74(11):2010–2019.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

June 10, 2022

Volume

74

Issue

11

Start / End Page

2010 / 2019

Location

United States

Related Subject Headings

  • Viral Load
  • United States
  • Tissue Donors
  • Prospective Studies
  • Microbiology
  • Integrases
  • Humans
  • HIV Seropositivity
  • HIV Infections
  • HIV