Kidney Donor’s HIV Strain Detected in HIV Positive Recipient Shortly After Transplant

Thursday, January 9, 2020
Mary E. Klotman, MD, and  Maria Blasi, PhD

Mary E. Klotman, MD, and  Maria Blasi, PhD

Human immunodeficiency virus, or HIV, is one of nature’s trickiest invaders, hijacking the biological makeup of a body’s own cells to infect and replicate. The persistence of HIV in different sites throughout the body of infected individuals has important implications for viral pathogenesis and cure strategies.

In a letter to the New England Journal of Medicine published Jan. 9, a team of researchers from the Division of Infectious Diseases in the Department of Medicine at Duke University describe how a specific viral strain from a deceased, HIV-positive kidney donor was present in renal cells sloughed from the organ and was detected in a transplant recipient, a 61-year-old, HIV-positive patient with polycystic kidney disease. The new strain, however, was no longer detected in the recipient after 16 days, consistent with successful control by the antiretroviral therapy the patient was receiving.

The team, led by Mary E. Klotman, MD, Dean of the Duke University School of Medicine, performed in-depth viral sequence analyses on biological samples such as blood, urine and tissue biopsy from both the recipient and donor during the peritransplant period to determine the presence of the strain. 

“We found HIV infection of cells intrinsic to the kidney in both the donor and recipient , suggesting that the kidney might serve as a reservoir for the virus. We will continue to monitor the recipient over time to determine any long-term implications on renal function and on viral replication and control,” said lead author Maria Blasi, PhD, assistant professor of medicine at Duke University School of Medicine.

“The HIV Organ Policy Equity (HOPE) Act, passed in 2013, modified organ donation rules to allow HIV positive donors to pass organs to HIV positive recipients. The act has increased the availability of transplant organs for people living with HIV in the United States and benefitted clinical research,” said Dr. Blasi.

“The passing of the HOPE Act is a tremendous step forward for patients, and also provides opportunities to conduct new studies that lead to important discoveries like this one,” said Dr. Klotman. “Now, we can track how HIV strains behave during an organ transplant, and this gives us important information about the virus that can help improve care for patients.”

Other co-authors include Hannah Stadtler; Jerry Chang; Marion Hemmersbach-Miller, MD, PhD; Christina Wyatt, MD; Paul Klotman, MD; Feng Gao, MD; and Cameron Wolfe, MD.