National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.
HIV
drug resistance
organ donation
transplant
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
10 06 2022
10 06 2022
Historique:
received:
12
03
2021
pubmed:
29
8
2021
medline:
15
6
2022
entrez:
28
8
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 34453519
pii: 6359095
doi: 10.1093/cid/ciab743
pmc: PMC9187316
doi:
Substances chimiques
Anti-Retroviral Agents
0
Integrases
EC 2.7.7.-
Banques de données
ClinicalTrials.gov
['NCT03500315', 'NCT03734393', 'NCT02602262']
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2010-2019Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI157893
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI134591
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM007445
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI094189
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI120938
Pays : United States
Investigateurs
Dominque Piquant
(D)
Katherine Link
(K)
Marion Hemmersbach-Miller
(M)
Thomas Pearson
(T)
Nicole Turgeon
(N)
G Marshall Lyon
(GM)
William Kitchens
(W)
Jeryl Huckaby
(J)
A Francie Lasseter
(AF)
Rivka Elbein
(R)
April Roberson
(A)
Elizabeth Ferry
(E)
Ethan Klock
(E)
Willa V Cochran
(WV)
Michelle Morrison
(M)
Sarah Rasmussen
(S)
Juli Bollinger
(J)
Jeremy Sugarman
(J)
Angela R Smith
(AR)
Margaret Thomas
(M)
Margaret Coakley
(M)
Joseph Timpone
(J)
Alyssa Stucke
(A)
Brandy Haydel
(B)
Rebecca Dieter
(R)
Elizabeth J Klein
(EJ)
Henry Neumann
(H)
Lorenzo Gallon
(L)
Leah Goudy
(L)
Michelle Callegari
(M)
Ilise Marrazzo
(I)
Towanda Jackson
(T)
Timothy Pruett
(T)
Mary Farnsworth
(M)
Jayme E Locke
(JE)
Darnell Mompoint-Williams
(D)
Katherine Basinger
(K)
Kristin Mekeel
(K)
Phirum Nguyen
(P)
Joanne Kwan
(J)
Tab Srisengfa
(T)
Peter Chin-Hong
(P)
Rodney Rogers
(R)
Jacques Simkins
(J)
Carlos Munoz
(C)
Ty Dunn
(T)
Dierdre Sawinski
(D)
Fernanda Silveira
(F)
Kailey Hughes
(K)
Diana Lynn Pakstis
(DL)
Jamie Nagy
(J)
Mary Baldecchi
(M)
Thangamani Muthukumar
(T)
Melissa D Eddie
(MD)
Katharine Robb
(K)
Elizabeth Salsgiver
(E)
Britta Witting
(B)
Marwan M Azar
(MM)
Merceditas Villanueva
(M)
Richard Formica
(R)
Ricarda Tomlin
(R)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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