Superinfection unlikely in HIV-positive to HIV-positive transplants, study suggests
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Donor-derived HIV superinfection “might not be a significant clinical concern” in transplants between people with HIV if the organ recipient is well monitored and virally suppressed on ART, researchers reported in The Lancet HIV.
The findings support data from a South African study published last year that demonstrated high rates of overall survival among HIV-positive patients who received a kidney from an HIV-positive donor, with no evidence of sustained superinfection.
“I hope that the message to reluctant transplant centers is that HIV superinfection shouldn’t be a concern if they want to start doing these transplants, under a properly approved research protocol,” Andrew D. Redd, PhD, staff scientist with the NIH’s National Institute of Allergy and Infectious Diseases, told Healio.
Redd and colleagues performed a mulitcenter, prospective, observational study in which they followed 14 HIV-positive to HIV-positive kidney recipients and eight liver transplant recipients for more than 3 years. They looked for evidence of sustained, donor-initiated HIV superinfections, and assessed donor blood samples for CD4 cell count, HIV RNA viral load and antiretroviral drug-resistant mutations.
Of the patients enrolled in the study, eight donors were virally suppressed (400 copies/mL or less) and the researchers detected no multiclass drug-resistant mutations among them. None of the recipients showed evidence of HIV superinfection, the researchers reported.
A single donor recipient had a viremic episode — a viral load of 2.08 million copies/mL — 3 years following transplantation due to non-adherence to ART. However, during the episode, only sequences from the recipient were found — implying that the donor virus was not reactivated even with temporary ART withdrawal.
“One thing I found not so much surprising but encouraging was the finding from our study, as well as the South African study, that in the two people — one in each study — who stopped taking ARVs against their physician’s advice, we found no evidence of the donor virus emerging after viral rebound,” Redd said. “I think this is a pretty strong indication that sustained superinfection is not occurring.”
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