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

2021; Oxford University Press; Volume: 74; Issue: 11 Linguagem: Inglês

10.1093/cid/ciab743

1537-6591

William A. Werbel, Diane Brown, Oyinkansola Kusemiju, Brianna Doby, Shanti Seaman, Andrew D. Redd, Yolanda Eby, Reinaldo E. Fernández, Niraj M. Desai, J. R. Miller, Gilad A. Bismut, Charles Kirby, H Schmidt, William Clarke, Michael Seisa, Christos J. Petropoulos, Thomas C. Quinn, Sander Florman, Shirish Huprikar, Meenakshi Rana, Rachel Friedman‐Moraco, Aneesh K. Mehta, Peter G. Stock, Jennifer C. Price, Valentina Stosor, Shikha Mehta, Alexander Gilbert, Nahel Elias, Michele I. Morris, Sameer Mehta, Catherine B. Small, Ghady Haidar, Maricar Malinis, Jennifer Husson, Marcus R. Pereira, Gaurav Gupta, Jonathan Hand, Varvara A. Kirchner, Avinash Kumar Ágarwal, Saima Aslam, Emily A. Blumberg, Cameron R. Wolfe, Kevin Myer, Robert 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 C. Pearson, Nicole A. Turgeon, G. Marshall Lyon, William H. Kitchens, Jeryl Huckaby, A Francie Lasseter, Rivka Elbein, April Roberson, Elizabeth Ferry, Ethan Klock, Willa Cochran, Michelle Morrison, Sarah E. Van Pilsum 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 L. Pruett, Mary Farnsworth, Jayme E. Locke, Darnell Mompoint-Williams, Katherine Basinger, Kristin L. Mekeel, Phirum Nguyen, Joanne Kwan, Tab Srisengfa, Peter Chin‐Hong, Rodney Rogers, Jacques Simkins, Carlos Muñoz, Ty B. Dunn, Dierdre Sawinski, Fernanda Silveira, Kailey Hughes, Diana L. Pakstis, Jamie Nagy, Mary Baldecchi, Thangamani Muthukumar, Melissa D Eddie, Katharine Robb, Elizabeth Salsgiver, Britta Witting, Marwan M. Azar, Merceditas Villanueva, Richard N. Formica, Ricarda Tomlin,

HIV Research and Treatment

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.