National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.
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Werbel William A, Brown Diane M, Kusemiju Oyinkansola T, Doby Brianna L, Seaman Shanti M, Redd Andrew D, Eby Yolanda, Fernandez Reinaldo E, Desai Niraj M, Miller Jernelle, Bismut Gilad A, Kirby Charles S, Schmidt Haley A, Clarke William A, Seisa Michael, Petropoulos Christos J, Quinn Thomas C, Florman Sander S, Huprikar Shirish, Rana Meenakshi M, Friedman-Moraco Rachel J, Mehta Aneesh K, Stock Peter G, Price Jennifer C, Stosor Valentina, Mehta Shikha G, Gilbert Alexander J, Elias Nahel, Morris Michele I, Mehta Sapna A, Small Catherine B, Haidar Ghady, Malinis Maricar, Husson Jennifer S, Pereira Marcus R, Gupta Gaurav, Hand Jonathan, Kirchner Varvara A, Agarwal Avinash, Aslam Saima, Blumberg Emily A, Wolfe Cameron R, Myer Kevin, Wood R Patrick, Neidlinger Nikole, Strell Sara, Shuck Marion, Wilkins Harry, Wadsworth Matthew, Motter Jennifer D, Odim Jonah, Segev Dorry L, Durand Christine M, Tobian Aaron A R, HOPE in Action Investigators
Аннотация
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.