Infectious Disease

Study provides reassuring results on HIV-to-HIV transplants

September 12, 2021

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Werbel does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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HIV-to-HIV transplants are on the rise, and according to a recent study, there are many donors with good organ quality and an acceptable risk profile for post-transplant ART to prevent HIV superinfection.

“There is persistent organ shortages in the United States and end organ disease is common in people with HIV.” Wilhelm A. Werbel, MD, a fellow at Johns Hopkins Medicine, said Healio.

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According to a recent study, there are many donors with good organ quality and acceptable risk profiles for an HIV-to-HIV transplant. Source: Adobe Stock.

William A. Werbel

“With the advent of great and safe antivirals, transplantation is a reality for people living with HIV, and the HOPE Act,” enacted in 2013 that makes transplantation of HIV-infected organs legal in the US, “has expanded access through use.” of organs from people with a positive HIV test to close the organ gap and save lives, ”said Werbel. “However, the organ donor population with HIV is not well described and this is a critical component in advising patients and providers on the safety of HIV-to-HIV practice.”

According to Werbel, it is difficult to assess donor traits and recipient outcomes from public and registry data because they cannot differentiate between people with HIV and people with false positive (FP) tests, and transplant providers often lack access to complete donor HIV data at the point- of care during the donor selection process.

“Otherwise, it is important to increase visibility and dialogue that people with HIV can both receive and donate organs to reduce stigma and misinformation about the practice,” he said.

As part of the HOPE in Action studies on HIV transplants between HIV-positive donors and recipients, Werbel and colleagues carried out a prospective study on donors with HIV-positive and HIV-FP tests. According to the study, the researchers compared the clinical characteristics of HIV-positive donors with those of FP donors and measured CD4 + T cells, HIV viral load (VL), drug resistance mutations, coreceptor tropism, and serum ART detection using mass spectrometry in HIV-positive Donor.

Between March 2016 and March 2020, 92 donors, 58 HIV positive and 34 FP donated, representing 98.9% of all US HOPE donors during that period, 131 kidneys and 46 livers.

According to the study, the prevalence of hepatitis B (16% vs. 0%), syphilis (16% vs. 0%) and cytomegalovirus (91% vs. 58%) was higher in HIV-positive compared to FP donors while The hepatitis C viraemia was similar (2% vs. 6%).

They found that most of the HIV-positive donors (71%) had a known diagnosis of HIV, 90% of whom were prescribed ART and 68% of whom received virus suppression. Their median CD4 count was 194 cells / ul and 42% had serious HIV drug resistance mutations, including non-nucleoside reverse transcriptase inhibitors (33%), integrase strand transfer inhibitors (INSTI, 4%), and multiclass ( 13%).

Werbel said that while HIV-to-HIV transplantation is still only allowed under the research protocol in the US, it is possible for the federal government to allow such transplants outside of the US for the next several years after a full review of the data from this study could research environment

“This study confirms that there are many donors with good organ quality and an acceptable risk profile, especially when it comes to trust in standard ART after transplantation to prevent HIV superinfection,” said Werbel. Future directions include understanding the full ‘iceberg’ of potential donors with HIV and barriers to donation, as well as building robust risk models to prospectively identify donors at greatest risk of resistance or opportunistic infection. “

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