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. 2022 Jan 6;19(1):4.
doi: 10.1186/s12985-021-01730-w.

Analysis of HIV quasispecies and virological outcome of an HIV D+/R+ kidney-liver transplantation

Gabriella Rozera  1 , Ubaldo Visco-Comandini  2 , Emanuela Giombini  3 , Francesco Santini  3 , Federica Forbici  3 , Giulia Berno  3 , Cesare Gruber  3 , Paolo De Paolis  4 , Roberto Colonnelli  4 , Gianpiero D'Offizi  2 , Giuseppe Maria Ettorre  5 , Paolo Grossi  6 , Maria Rosaria Capobianchi  3 , Giuseppe Ippolito  7 , Isabella Abbate  3
Affiliations

Analysis of HIV quasispecies and virological outcome of an HIV D+/R+ kidney-liver transplantation

Gabriella Rozera et al. Virol J. .

Abstract

Introduction: Transplantation among HIV positive patients may be a valuable therapeutic intervention. This study involves an HIV D+/R+ kidney-liver transplantation, where PBMC-associated HIV quasispecies were analyzed in donor and transplant recipients (TR) prior to transplantation and thereafter, together with standard viral monitoring.

Methods: The donor was a 54 year of age HIV infected woman: kidney and liver recipients were two HIV infected men, aged 49 and 61. HIV quasispecies in PBMC was analyzed by ultra-deep sequencing of V3 env region. During TR follow-up, plasma HIV-1 RNA, HIV-1 DNA in PBMC, analysis of proviral integration sites and drug-resistance genotyping were performed. Other virological and immunological monitoring included CMV and EBV DNA quantification in blood and CD4 T cell counts.

Results: Donor and TR were all ART-HIV suppressed at transplantation. Thereafter, TR maintained a nearly suppressed HIV-1 viremia, but HIV-1 RNA blips and the increase of proviral integration sites in PBMC attested some residual HIV replication. A transient peak in HIV-1 DNA occurred in the liver recipient. No major changes of drug-resistance genotype were detected after transplantation. CMV and EBV transient reactivations were observed only in the kidney recipient, but did not require specific treatment. CD4 counts remained stable. No intermixed quasispecies between donor and TR was observed at transplantation or thereafter. Despite signs of viral evolution in TR, HIV genetic heterogeneity did not increase over the course of the months of follow up.

Conclusions: No evidence of HIV superinfection was observed in the donor nor in the recipients. The immunosuppressive treatment administrated to TR did not result in clinical relevant viral reactivations.

Keywords: HIV; Quasispecies; Solid organ transplantation; Viral reactivation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Kinetics of HIV-1 viremia and peripheral blood cellular reservoir of the infection in TR during the follow-up. Kinetics of HIV-1 RNA in plasma (blue line) and HIV-1 DNA in PBMC (red line) during the follow-up in kidney (A) and liver (B) recipients. The dotted line indicates the limit of quantification of HIV-1 RNA
Fig. 2
Fig. 2
Phylogenetic tree of donor and recipients env sequences. Phylogenetic tree constructed with all the representative env sequences obtained from donor (green), kidney recipient (red/orange shades) and liver recipient (blue shades) at all time points. Bootstrap values > 85% were considered statistically significant (*). In the insert, complexity (normalized Shannon entropy) associated with each sample, from each patient, at the indicated time of collection, is shown
See this image and copyright information in PMC

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