Kaposi Sarcoma–Associated Herpesvirus Risk and Disease in Kidney Donors and Transplant Recipients With HIV in the United States
Puja H. Nambiar, Tao Liang, Nazzarena Labò, Jonathan Hand, Emily A. Blumberg, Meenakshi Rana, Sander Florman, Brandy Haydel, Michele I. Morris, Joanna Schaenman, Moreno Magalhães de Souza Rodrigues, William A. Werbel, Mary G. Bowring, Rachel Friedman‐Moraco, Peter G. Stock, Valentina Stosor, Shikha Mehta, Alexander Gilbert, Nahel Elias, Sameer Mehta, Catherine B. Small, Ghady Haidar, Maricar Malinis, Marcus R. Pereira, Saima Aslam, David Wojciechowski, Ricardo M. La Hoz, Carlos A.Q. Santos, Senu Apewokin, Jose A. Castillo-Lugo, Karthik Ranganna, Megan Morsheimer, Allan B. Massie, Dorry L. Segev, Wendell Miley, Vickie Marshall, Denise Whitby, Aaron A.R. Tobian, Christine M. Durand
Abstract
BACKGROUND: Due to high prevalence of Kaposi sarcoma-associated herpesvirus (KSHV) among people with human immunodeficiency virus (HIV), KSHV-associated disease (KAD) may be increased after kidney transplantation from donors with HIV (HIV D+) to recipients with HIV (HIV R+). METHODS: Anti-KSHV antibodies were measured in HIV R+ and donors with and without HIV (HIV D-) using a 30-antigen multiplex assay within 3 multicenter kidney transplantation studies. KSHV seropositivity was defined as reactivity to conventional KSHV antigens (≥1 ORF73 or K8.1); reactivity to expanded 5-antigen and 30-antigen panels were also reported. Risk factors were identified using modified Poisson regression. Recipients were monitored for posttransplant anti-KSHV antibody changes and KAD. RESULTS: KSHV seroprevalence was 40.6% (143/352) among HIV R+, 25.2% (33/131) among HIV D+, and 7.5% (4/53) among HIV D-. In the multivariable model, only men who have sex with men (MSM) status was associated with KSHV seropositivity (relative risk, 1.51 [95% confidence interval {CI}, 1.07-2.14] in recipients and 2.39 [95% CI, 1.03-5.53] in donors). Among 418 HIV R+ (215 HIV D+/R+, 203 HIV D-/R+), there were 5 KAD cases (incidence, 0.63 cases/100 person-years [95% CI, .26-1.52]): 3 skin-only Kaposi sarcoma (KS), 1 multicentric Castleman disease, and 1 allograft KS. The allograft KS occurred in a female HIV D+/R+ and was likely donor derived. Remaining KAD cases occurred in male HIV D-/R+ and were likely recipient KSHV reactivation or acquisition. CONCLUSIONS: In the United States, KSHV seroprevalence in donors and recipients with HIV was high, particularly among MSM. Reassuringly, KSHV-associated disease was rare and primarily attributed to recipient rather than donor-derived KSHV.