National Landscape of Human Immunodeficiency Virus–Positive Deceased Organ Donors in the United States
Authors: 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, Piquant Dominque , Link Katherine , Hemmersbach-Miller Marion , Pearson Thomas , Turgeon Nicole , Lyon G Marshall , Kitchens William , Huckaby Jeryl , Lasseter A Francie , Elbein Rivka , Roberson April , Ferry Elizabeth , Klock Ethan , Cochran Willa V , Morrison Michelle , Rasmussen Sarah , Bollinger Juli , Sugarman Jeremy , Smith Angela R , Thomas Margaret , Coakley Margaret , Timpone Joseph , Stucke Alyssa , Haydel Brandy , Dieter Rebecca , Klein Elizabeth J , Neumann Henry , Gallon Lorenzo , Goudy Leah , Callegari Michelle , Marrazzo Ilise , Jackson Towanda , Pruett Timothy , Farnsworth Mary , Locke Jayme E , Mompoint-Williams Darnell , Basinger Katherine , Mekeel Kristin , Nguyen Phirum , Kwan Joanne , Srisengfa Tab , Chin-Hong Peter , Rogers Rodney , Simkins Jacques , Munoz Carlos , Dunn Ty , Sawinski Dierdre , Silveira Fernanda , Hughes Kailey , Pakstis Diana Lynn , Nagy Jamie , Baldecchi Mary , Muthukumar Thangamani , Eddie Melissa D , Robb Katharine , Salsgiver Elizabeth , Witting Britta , Azar Marwan M , Villanueva Merceditas , Formica Richard , Tomlin Ricarda 
Published: August 2021

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 &lt;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.