Donor-derived HIV superinfection rare following transplant

Last Updated: 2020-08-20

By Will Boggs MD

NEW YORK (Reuters Health) - Donor-derived HIV superinfection appears to be rare following HIV-positive to HIV-positive kidney and liver transplantation, according to a new study.

"These findings further support work from South Africa that showed that in HIV+ to HIV+ organ recipients, who maintain viral suppression, the risk of HIV superinfection shouldn't be a major concern," Dr. Andrew D. Redd of Johns Hopkins University School of Medicine, in Baltimore, Maryland, told Reuters Health by email.

The HIV Organ Policy Equity (HOPE) Act of 2013 allows for HIV-positive to HIV-positive transplantation under research protocols. Some have raised concerns about the risk of HIV superinfection arising as a result of the high viral inoculum associated with an organ transplant.

Dr. Redd and colleagues followed 14 recipients of HIV-positive-to-HIV-positive kidney transplant and eight recipients of HIV-positive-to-HIV-positive liver transplant for evidence of sustained donor-derived HIV superinfection as part of the larger HOPE pilot study that is assessing the feasibility and safety of such transplants.

Eleven of the 14 donors were reported to be on antiretroviral therapy (ART; ART history was not available for the other three donors). Eight donors were virally suppressed, and six had viral loads ranging from 475 to >3 million copies/mL.

HIV viral load remained suppressed for all transplant recipients throughout the posttransplantation follow-up period, except for one patient who had a viremic episode year years after transplantation that resulted from nonadherence to ART, the team reports in The Lancet HIV.

Among the 17 transplant recipients who had appropriate next-generation-sequencing data to examine for HIV superinfection, none had sequences matching donor sequences. Similarly, phylogenetic analyses of recipient sequences indicated no evidence of HIV superinfection.

Moreover, only recipient virus sequences could be detected in the serum taken during the viremic episode due to ART nonadherence.

"My hope would be that these findings would help to convince reluctant surgeons and transplant centers that HIV superinfection in properly managed patients shouldn't be a concern," Dr. Redd said. "One thing I would like to add is that if you are a person living with HIV, or anyone for that matter, please consider registering to become an organ donor."

"Although these preliminary findings might be reassuring to transplant providers and patients, further monitoring of viral populations in a larger cohort of HIV-positive transplant recipients is needed to investigate and fully assess the clinical and virological significance of donor-derived HIV superinfection," the authors conclude.

SOURCE: https://bit.ly/3koe9FG The Lancet HIV, online July 27, 2020.