The need for organ transplantation in HIV-positive individuals is growing due to a rising prevalence of end-stage renal and liver disease. Excellent outcomes of transplantation in HIV-positive individuals have been achieved using HIV-negative donors. However, due to a major organ shortage and a high waitlist mortality for HIV-positive individuals in particular, a novel source of organs is desperately needed. Organs from HIV-positive deceased donors (HIVDD) are a unique potential resource for HIV-positive individuals awaiting transplantation. By expanding the donor pool by potentially >2400 HIVDD annually, the use of HIVDD could also decrease the wait time for HIV-negative individuals, resulting in a far-reaching public health impact. Recognition of this need led to the passage of the HIV Organ Policy Equity (HOPE) Act by Congress and signed by President Obama, calling for research on HIV-to-HIV organ transplants. However, critical questions remain surrounding the use of HIVDD. With the support of the United Network of Organ Sharing (UNOS) and the Association of Organ Procurement Organizations (AOPO), we aim to define the epidemiology and HIV-specific biology of the HIVDD pool. Leveraging the existing infrastructure of UNOS and the OPOs, we will perform a comprehensive evaluation of potential HIVDDs and their recipients. First, we will define the size of the HIVDD pool and the distribution of demographic factors, comorbidities, HIV viral load, CD4 count, and use of antiretroviral therapy (ART) using rapid screens that are standard in deceased donor evaluation. Second, we will perform more time-intensive assays to determine the prevalence of potential contraindications to donation, such as extensive ART resistance, that cannot be assessed during the rapid screening window. Third, we will explore prediction models to determine whether rapid screening can estimate the risk of potential HIV-specific contraindications to donation. Finally, we will evaluate HIV-to HIV transplant recipient safety through a prospective observational study of HIV-to-HIV renal transplantation and also through mandated data collection by the Scientific Registry for Transplant Recipients. Understanding the HIVDD pool is critical for clinical decision-making (i.e. assessing individual risk) and for policy-making (i.e. whether it is safe enough to merit the use o some, or even all, HIVDD). We have assembled a team led by an early stage investigator with expertise in HIV epidemiology, laboratory testing, and leading multidisciplinary studies, a well-respected transplant surgeon with experience influencing national policy, researchers in basic HIV biology from Johns Hopkins and the NIH, an industry leader in diagnostic virology, AOPO, and UNOS. The HOPE Act directs the Secretary of HHS to develop guidelines for research related to HIVDD organ transplantation. Our study will provide critical information that can be immediately used to address this mandate. If the use of HIVDD can be safely implemented, thousands of lives of HIV-positive and HIV-negative individuals can be saved with potentially the largest expansion of the organ donor pool in the last decade.

Public Health Relevance

Thousands of individuals, including many with HIV-infection (HIV+) die every year waiting for an organ transplant due to a critical shortage of donor organs. Organs from HIV+ deceased donors transplanted into HIV+ recipients could save lives of individuals on the waiting list but this practice was illegal, until November 2013 when Congress signed the HOPE (HIV Organ Policy Equity) Act. This project will study the impact and feasibility of using HIV+ deceased donors in order to provide guidance for health professionals and policymakers.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI120938-02
Application #
9185270
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Odim, Jonah
Project Start
2015-12-01
Project End
2020-11-30
Budget Start
2016-12-01
Budget End
2017-11-30
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Pathology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Patel, Eshan U; Mehta, Shruti H; Boon, Denali et al. (2018) Limited Coverage of Hepatitis C Virus Testing in the United States, 2013-2017. Clin Infect Dis :
Bynum, Jennifer P; Zachary, Andrea; Ness, Paul M et al. (2018) Transfusion of leukoreduced blood products and risk of antibody-mediated rejection of renal allografts. Transfusion 58:1951-1957
Nguyen, Anh Q; Anjum, Saad K; Halpern, Samantha E et al. (2018) Willingness to Donate Organs Among People Living With HIV. J Acquir Immune Defic Syndr 79:e30-e36
Patel, Eshan U; Grabowski, M Kate; Eisenberg, Anna L et al. (2018) Increases in Human Papillomavirus Vaccination Among Adolescent and Young Adult Males in the United States, 2011-2016. J Infect Dis 218:109-113
Goel, Ruchika; Chappidi, Meera R; Patel, Eshan U et al. (2018) Trends in Red Blood Cell, Plasma, and Platelet Transfusions in the United States, 1993-2014. JAMA 319:825-827
Durand, Christine M; Halpern, Samantha E; Bowring, Mary G et al. (2018) Organs from deceased donors with false-positive HIV screening tests: An unexpected benefit of the HOPE act. Am J Transplant 18:2579-2586
Van Pilsum Rasmussen, Sarah E; Bowring, Mary Grace; Shaffer, Ashton A et al. (2018) Knowledge, attitudes, and planned practice of HIV-positive to HIV-positive transplantation in US transplant centers. Clin Transplant 32:e13365
Cash, Ayla; Luo, Xun; Chow, Eric K H et al. (2018) HIV+ deceased donor referrals: A national survey of organ procurement organizations. Clin Transplant 32:
Durand, Christine M; Bowring, Mary G; Thomas, Alvin G et al. (2018) The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study. Ann Intern Med 168:702-711
Doby, Brianna L; Tobian, Aaron A R; Segev, Dorry L et al. (2018) Moving from the HIV Organ Policy Equity Act to HIV Organ Policy Equity in action: changing practice and challenging stigma. Curr Opin Organ Transplant 23:271-278

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