National Landscape of Human Immunodeficiency Virus–Positive Deceased Organ Donors in the United States-Reference-Cited by-同舟云学术

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

Published:2021-08-28 Issue: Volume: Page:
ISSN:1058-4838
Container-title:Clinical Infectious Diseases
language:en
Short-container-title:

Author:

Werbel William A¹^ORCID,Brown Diane M¹,Kusemiju Oyinkansola T¹,Doby Brianna L¹,Seaman Shanti M¹,Redd Andrew D¹²³,Eby Yolanda²,Fernandez Reinaldo E¹,Desai Niraj M⁴,Miller Jernelle²,Bismut Gilad A²,Kirby Charles S⁵,Schmidt Haley A²,Clarke William A²,Seisa Michael⁶,Petropoulos Christos J⁶,Quinn Thomas C¹²³,Florman Sander S⁷,Huprikar Shirish⁸,Rana Meenakshi M⁸,Friedman-Moraco Rachel J⁹,Mehta Aneesh K⁹,Stock Peter G¹⁰,Price Jennifer C¹¹,Stosor Valentina¹²,Mehta Shikha G¹³,Gilbert Alexander J¹⁴,Elias Nahel¹⁵,Morris Michele I¹⁶,Mehta Sapna A¹⁷,Small Catherine B¹⁸,Haidar Ghady¹⁹,Malinis Maricar²⁰^ORCID,Husson Jennifer S²¹,Pereira Marcus R²²,Gupta Gaurav²³,Hand Jonathan²⁴,Kirchner Varvara A²⁵,Agarwal Avinash²⁶,Aslam Saima²⁷,Blumberg Emily A²⁸,Wolfe Cameron R²⁹,Myer Kevin³⁰,Wood R Patrick³¹,Neidlinger Nikole³¹³²,Strell Sara³²,Shuck Marion³³,Wilkins Harry³³,Wadsworth Matthew³⁴,Motter Jennifer D⁴,Odim Jonah³⁵,Segev Dorry L⁴,Durand Christine M¹,Tobian Aaron A R²,Piquant Dominque,Link Katherine,Hemmersbach-Miller Marion,Pearson Thomas,Turgeon Nicole,Lyon G Marshall,Kitchens William,Huckaby Jeryl,Lasseter A Francie,Elbein Rivka,Roberson April,Ferry Elizabeth,Klock Ethan,Cochran Willa V,Morrison Michelle,Rasmussen Sarah,Bollinger Juli,Sugarman Jeremy,Smith Angela R,Thomas Margaret,Coakley Margaret,Timpone Joseph,Stucke Alyssa,Haydel Brandy,Dieter Rebecca,Klein Elizabeth J,Neumann Henry,Gallon Lorenzo,Goudy Leah,Callegari Michelle,Marrazzo Ilise,Jackson Towanda,Pruett Timothy,Farnsworth Mary,Locke Jayme E,Mompoint-Williams Darnell,Basinger Katherine,Mekeel Kristin,Nguyen Phirum,Kwan Joanne,Srisengfa Tab,Chin-Hong Peter,Rogers Rodney,Simkins Jacques,Munoz Carlos,Dunn Ty,Sawinski Dierdre,Silveira Fernanda,Hughes Kailey,Pakstis Diana Lynn,Nagy Jamie,Baldecchi Mary,Muthukumar Thangamani,Eddie Melissa D,Robb Katharine,Salsgiver Elizabeth,Witting Britta,Azar Marwan M,Villanueva Merceditas,Formica Richard,Tomlin Ricarda,

Affiliation:

1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

2. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

3. Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA

4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

5. Department of Biochemistry, Cellular, and Molecular Biology, Johns Hopkins University, Baltimore, Maryland, USA

6. Laboratory Corporation of America (LabCorp), South San Francisco, California, USA

7. Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York City, New York, USA

8. Department of Medicine, Division of Infectious Diseases, The Mount Sinai Hospital, New York City, New York, USA

9. Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA

10. Department of Surgery, University of California San Francisco, San Francisco, California, USA

11. Department of Medicine, University of California San Francisco, San Francisco, California, USA

12. Division of Infectious Disease and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

13. Section of Transplant Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA

14. MedStar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC, USA

15. Department of Surgery, Division of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

16. Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA

17. New York University Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA

18. Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, USA

19. Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

20. Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA

21. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA

22. Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA

23. Department of Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia, USA

24. Department of Infectious Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana, USA

25. Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA

26. Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, Virginia, USA

27. Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA

28. Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

29. Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA

30. LifeGift, Houston, Texas, USA

31. Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, Wisconsin, USA

32. UW Health Organ Procurement Organization, Madison, Wisconsin, USA

33. Gift of Hope, Chicago, Illinois, USA

34. Life Connection, Dayton, Ohio, USA

35. Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA

Abstract

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.

Funder

National Institutes of Health

Division of Intramural Research, National Institute of Allergy and Infectious Diseases

National Institute of Diabetes and Digestive and Kidney Diseases

American Society of Transplantation

Johns Hopkins School of Medicine

Johns Hopkins University Center for AIDS Research

The Living Legacy Foundation

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)