Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2022 Jun 10;74(11):2010-2019. doi: 10.1093/cid/ciab743.
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.
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.
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.
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.
从艾滋病毒（HIV）阳性供体向 HIV 阳性（HIV D+/R+）受者移植器官存在供体源性感染的风险。了解 HIV 阳性供体的临床、免疫和病毒学特征对于确保安全至关重要。
我们在 HIV D+/R+移植的 HIV 器官政策公平（HOPE）法案行动研究中（ClinicalTrials.gov NCT02602262、NCT03500315 和 NCT03734393），对 HIV 阳性和 HIV 假阳性（FP）检测结果的供体进行了前瞻性研究。我们比较了 HIV 阳性供体与 FP 供体的临床特征。我们使用质谱法测量了 HIV 阳性供体的 CD4 T 细胞、HIV 病毒载量（VL）、耐药突变（DRMs）、核心受体嗜性和血清抗逆转录病毒治疗（ART）检测。
2016 年 3 月至 2020 年 3 月，92 名供体（58 名 HIV 阳性，34 名 FP），占该期间所有美国 HOPE 供体的 98.9%，捐献了 177 个器官（131 个肾脏和 46 个肝脏）。每年供体数量都在增加。与 FP 供体相比，HIV 阳性供体的乙型肝炎（16%对 0%）、梅毒（16%对 0%）和巨细胞病毒（CMV；91%对 58%）的患病率更高；丙型肝炎病毒血症的患病率相似（2%对 6%）。大多数 HIV 阳性供体（71%）有明确的 HIV 诊断，其中 90%接受了 ART 治疗，68%的 VL<400 拷贝/mL。中位 CD4 T 细胞计数（四分位距）为 194/µL（77-331/µL），中位 CD4 T 细胞百分比为 27.0%（16.8%-36.1%）。42%检测到主要 HIV DRMs，包括非核苷类逆转录酶抑制剂（33%）、整合酶链转移抑制剂（4%）和多类（13%）。46%检测到血清 ART，且与病史匹配的 ART 治疗。
HIV 阳性供体器官的使用正在增加。HIV DRMs 很常见，但很少有会影响基于整合酶链转移抑制剂方案的耐药性，这对于安全性来说是令人欣慰的。
