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

William A. Werbel*, Diane M. Brown, Oyinkansola T. Kusemiju, Brianna L. Doby, Shanti M. Seaman, Andrew D. Redd, Yolanda Eby, Reinaldo E. Fernandez, Niraj M. Desai, Jernelle Miller, Gilad A. Bismut, Charles S. Kirby, Haley A. Schmidt, William A. Clarke, Michael Seisa, Christos J. Petropoulos, Thomas C. Quinn, Sander S. Florman, Shirish Huprikar, Meenakshi M. RanaRachel J. Friedman-Moraco, Aneesh K. Mehta, Peter G. Stock, Jennifer C. Price, Valentina Stosor, Shikha G. Mehta, Alexander J. Gilbert, Nahel Elias, Michele I. Morris, Sapna A. Mehta, Catherine B. Small, Ghady Haidar, Maricar Malinis, Jennifer S. Husson, Marcus R. Pereira, Gaurav Gupta, Jonathan Hand, Varvara A. Kirchner, Avinash Agarwal, Saima Aslam, Emily A. Blumberg, Cameron R. Wolfe, Kevin Myer, R. Patrick Wood, Nikole Neidlinger, Sara Strell, Marion Shuck, Harry Wilkins, Matthew Wadsworth, Jennifer D. Motter, Jonah Odim, Dorry L. Segev, Christine M. Durand, Aaron A.R. Tobian, Dominque Piquant, Katherine Link, Marion Hemmersbach-Miller, Thomas Pearson, Nicole Turgeon, G. Marshall Lyon, William Kitchens, Jeryl Huckaby, A. Francie Lasseter, Rivka Elbein, April Roberson, Elizabeth Ferry, Ethan Klock, Willa V. Cochran, Michelle Morrison, Sarah Rasmussen, Juli Bollinger, Jeremy Sugarman, Angela R. Smith, Margaret Thomas, Margaret Coakley, Joseph Timpone, Alyssa Stucke, Brandy Haydel, Rebecca Dieter, Elizabeth J. Klein, Henry Neumann, Lorenzo Gallon, Leah Goudy, Michelle Callegari, Ilise Marrazzo, Towanda Jackson, Timothy Pruett, Mary Farnsworth, Jayme E. Locke, Darnell Mompoint-Williams, Katherine Basinger, Kristin Mekeel, Phirum Nguyen, Joanne Kwan, Tab Srisengfa, Peter Chin-Hong, Rodney Rogers, Jacques Simkins, Carlos Munoz, Ty Dunn, Dierdre Sawinski, Fernanda Silveira, Kailey Hughes, Diana Lynn Pakstis, Jamie Nagy, Mary Baldecchi, Thangamani Muthukumar, Melissa D. Eddie, Katharine Robb, Elizabeth Salsgiver, Britta Witting, Marwan M. Azar, Merceditas Villanueva, Richard Formica, Ricarda Tomlin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2010-2019
Number of pages10
JournalClinical Infectious Diseases
Volume74
Issue number11
DOIs
StatePublished - Jun 1 2022

Keywords

  • HIV
  • drug resistance
  • organ donation
  • transplant

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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