Awaiting Organ Transplant, HIV
Conditions
Keywords
HIV, Kidney Transplant, Liver Transplant, Transplant
Brief summary
HIV-infected (HIV+) individuals who agree to accept and receive a solid organ transplant from an HIV+ deceased donor will be followed to determine the safety and efficacy of this practice. HIV+ individuals who receive a solid organ transplant from HIV-uninfected donors will also be followed.
Detailed description
This is an observational study designed to evaluate safety and outcomes of solid organ transplantation in HIV+ recipients of HIV+ deceased donors. This study will evaluate overall survival and graft survival compared to transplantation with an HIV- organ. In addition the study will assess potential complications of organ transplant using HIV+ deceased donors - including but not limited to - HIV superinfection, incidence and severity of graft rejection, recurrence of HIV-associated nephropathy, incidence of bacterial infections, and opportunistic infections.
Interventions
None listed
Sponsors
Massachusetts General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Participant is able to understand and provide informed consent 2. Participant meets standard listing criteria for transplant. 3. Documented HIV infection (by any licensed ELISA and confirmation by Western Blot, positive HIV ab IFA, or documented history of detectable HIV-1 RNA). 4. Participant is ≥ 18 years old. 5. Opportunistic Complications: None or previous history of protocol allowed opportunistic infections or neoplasms with appropriate acute and maintenance therapy and no evidence of active disease. 6. Participant CD4+ T-cell count is \>/= 200/μL prior to renal transplant or for liver transplant is \>/= 100/μL within 16 weeks prior to transplant and no history of opportunistic infection (OI); or ≥200 μL if history of OI is present. 7. Participant HIV-1 RNA \< 50 copies/mL (by any FDA-approved assay performed in CLIA-approved laboratory), in the 26 weeks prior to transplant. Non-consecutive viral blips between 50-400 copies RNA/mL will be allowed. 8. Antiretroviral therapy: To avoid drug interactions, ritonavir or cobicistat-containing regimens are not recommended, unless in the opinion of the HIV/Transplant Infectious Disease team there is no alternative regimen expected to control HIV replication. 9. Participant is willing to use PCP, herpes virus and fungal prophylaxis as indicated.
Exclusion criteria
1. Participant has concomitant conditions that, in the judgment of the investigators, would preclude transplantation or immunosuppression. 2. Opportunistic Complication History: Any history of progressive multifocal leukoencephalopathy (PML), chronic intestinal cryptosporidiosis of \> 1 month duration, or primary CNS lymphoma. 3. Participant has a history of any neoplasm except for the following: resolved kaposi's sarcoma, in situ anogenital carcinoma, adequatelytreated basal or squamous cell carcinoma of the skin, solid tumors (except primary CNS lymphoma) treated with curative therapy and disease free for more than 5 years. History of renal cell carcinoma requires disease free state for 2 years. History of leukemia and disease-free duration will be per site policy. 4. Participant is pregnant or breastfeeding. Note: Participants who become pregnant post-transplant will continue to be followed in the study and will be managed per clinical practice. Women that become pregnant should not breastfeed.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Patient Survival | One Year |
Secondary
| Measure | Time frame |
|---|---|
| Graft Rejection | One, Two, Three Years |
| HIV Disease Progression | One, Two, Three Years |
| Development of antiretroviral resistance and X4 tropic virus | Through study completion, up to three years |
| Incidence of bacterial, fungal, viral and other opportunistic infections | Through study completion, up to three years |
| Graft Survival | One, Two, Three Years |
| Analysis of recurrent HIV associated nephropathy | Through study completion, up to three years |
| Incidence of post-transplant malignancies | Through study completion, up to three years |
| Incidence of systemic HIV-superinfection | Through study completion, up to three years |
| Changes in HIV latent viral reservoir | Through study completion, up to three years |
| Incidence of other transplant complications (surgical and vascular) | Through study completion, up to three years |
Countries
United States
Outcome results
None listed