By writer to www.medpagetoday.com
Strains of HIV from an contaminated kidney donor confirmed up in an HIV-positive transplant recipient’s physique fluids, in addition to the native kidneys.
At this level, nevertheless, the discovering seems to be simply an attention-grabbing factoid and never a motive for concern.
Donor-derived HIV sequences had been detected within the recipient’s blood and urine as much as 16 days after the transplant process, reported Mary Klotman, MD, of Duke College Medical Middle in Durham, North Carolina, and colleagues.
However whereas HIV sequences from the donor had been detectable in renal cells cultured from the recipient’s urine 12 hours after transplant, renal cells on day 9 solely confirmed the recipient’s pressure, they wrote in a “Correspondence” within the New England Journal of Medicine.
The HIV Organ Policy Equity (HOPE) Act means that patients living with HIV can accept HIV-positive donor organs, they noted. And HIV-positive kidney donors have been in the news recently.
Last year, researchers at Johns Hopkins University in Baltimore reported on the case of Nina Martinez, the primary dwelling kidney donor with HIV. Surgeons carried out a kidney transplant from Martinez to a recipient additionally dwelling with HIV in March 2019. They famous Martinez’s HIV was well-controlled.
On this case from Klotman and colleagues, the deceased donor was viremic, with an HIV viral load of over 183,000 copies/mL. The recipient, age 61, had polycystic kidney illness and was virally suppressed, with a viral load beneath 20 copies/mL and on antiretroviral remedy with abacavir, lamivudine, and raltegravir.
Twelve hours after transplant, researchers detected 10 HIV sequences in renal cells cultured from the affected person’s urine — 4 that belonged to the recipient, and 6 that belonged to the donor. However on day 9, all sequences corresponded to the recipient’s HIV pressure.
The authors additionally famous that at day 42 following transplantation, a “viral blip” of 75 copies/mL was discovered within the recipient’s plasma, however solely the recipient’s pressure may very well be amplified.
Klotman characterised these findings to MedPage Right this moment as “an attention-grabbing scientific commentary that warrants longitudinal follow-up” to see if the scientific findings correlate to medical findings. However she emphasised that the report “does not present any proof of detrimental implications for sufferers” when in comparison with the good thing about a transplant.
The authors urged long-term follow-up to measure “the impact of renal HIV an infection on long-term allograft perform,” however Klotman mentioned there is no proof this impacts the functioning of the transplant.
“Our commentary means that [recipients] must be adopted, however I would not make any choice about turning down a transplant as a result of there may be a possible [HIV] mutation within the donor. There isn’t any proof to recommend that is a consequence,” she famous.
The examine was supported by the Nationwide Institute of Diabetes and Digestive and Kidney Ailments (NIDDK) and the Nationwide Institute of Allergy and Infectious Ailments (NIAID).
Klotman disclosed assist from the NIDDK. Co-authors disclosed assist from the NIDDK and NIAID.
— to www.medpagetoday.com