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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; [...]

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

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  • Media type: E-Article
  • Title: National Landscape of Human Immunodeficiency Virus–Positive Deceased Organ Donors in the United States
  • Contributor: 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; [...]
  • Published: Oxford University Press (OUP), 2022
  • Published in: Clinical Infectious Diseases, 74 (2022) 11, Seite 2010-2019
  • Language: English
  • DOI: 10.1093/cid/ciab743
  • ISSN: 1058-4838; 1537-6591
  • Origination:
  • Footnote:
  • Description: 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.
  • Access State: Open Access