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