CLINICAL RESEARCH UPDATE

by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

October 22, 2024


Featured Literature:

Durand CM, Massie A, Florman S, et al; HOPE in Action Investigators.  Safety of kidney transplantation from donors with HIV. New Engl J Med.  2024 Oct 17;391(15):1390-1401.  Doi:10.1056/NEJMoa2403733.

This multicenter, observational study compared kidney transplantation outcomes involving deceased donors with and without HIV among adult recipients with HIV (D+/R+ vs. D-/R+).  Investigators also determined incidence of breakthrough infection (defined as at least two consecutive viral load measurements greater than 200 copies/mL or one measurement greater than 1000 copies/mL), HIV superinfection, post-transplantation complications, and survival-related outcomes.  All transplant recipients had CD4+ cell count of at least 200 cells/mm3 and virologic suppression to less than 50 copies/mL on ART, and could not have an active opportunistic infection, history of progressive multifocal leukoencephalopathy, or central nervous system lymphoma.  Participants received a kidney from a donor with or without HIV (whichever was available first) following standard transplant considerations (e.g., blood type, HLA matching, and geographic location).  Analyses involved 198 participants (99 D+/R+ and 99 D-/R+); median follow-up was 2.2 years for the D+/R+ group vs. 2.3 years for the D-/R+ group.  For the composite primary outcome which included all-cause mortality, graft loss, serious adverse event, breakthrough infection, persistent ART failure, or opportunistic infection, the adjusted hazard ratio was 1.00, demonstrating noninferiority.  1-year and 3-year incidence of rejection was 13% among recipients of kidneys from donors with HIV and 21% among recipients of kidneys from donors without HIV, and 21% and 24%, respectively.  One case of potential HIV superinfection was identified.

Author’s Commentary:

In this analysis from the HOPE in Action Investigators group, outcomes for overall survival, graft survival, and rejection events were similar for kidney transplant recipients with HIV, regardless of donor HIV status.  These findings herald an important step forward in improving access to solid organ transplantation for people with HIV and end stage kidney disease.  Additionally, some observations from this work (e.g., lower incidence of rejection compared to prior studies) highlight the role of induction therapy and ART optimization, as well as pre-transplant hepatitis C treatment.  Authors indicate these outcomes “support the expansion of kidney transplantation involving donors and recipients with HIV from research to clinical care.”

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