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. 2025 May 5:ciaf229.
doi: 10.1093/cid/ciaf229. Online ahead of print.

Kaposi Sarcoma-Associated Herpesvirus Risk and Disease in Kidney Donors and Transplant Recipients with HIV in the United States

Puja Nambiar  1 , Tao Liang  2 , Nazzarena Labo  3 , Jonathan Hand  4 , Emily A Blumberg  5 , Meenakshi M Rana  6 , Sander Florman  7 , Brandy Haydel  7 , Michele I Morris  8 , Joanna Schaenman  9 , Moreno M S Rodrigues  2 , William A Werbel  2 , Mary G Bowring  2 , Rachel J Friedman-Moraco  10 , Peter Stock  11 , Valentina Stosor  12 , Shikha Mehta  13 , Alexander J Gilbert  14 , Nahel Elias  15 , Sapna A Mehta  16 , Catherine B Small  17 , Ghady Haidar  18 , Maricar Malinis  19 , Marcus R Pereira  20 , Saima Aslam  21 , David Wojciechowski  22 , Ricardo La Hoz  22 , Carlos A Q Santos  23 , Senu Apewokin  24 , Jose A Castillo-Lugo  25 , Karthik Ranganna  26 , Megan Morsheimer  27 , Allan Massie  16 , Dorry L Segev  16 , Wendell Miley  3 , Vickie Marshall  3 , Denise Whitby  3 , Aaron A A Tobian  2 , Christine M Durand  2
Affiliations

Kaposi Sarcoma-Associated Herpesvirus Risk and Disease in Kidney Donors and Transplant Recipients with HIV in the United States

Puja Nambiar et al. Clin Infect Dis. .

Abstract

Background: Due to high prevalence of Kaposi Sarcoma (KS)-Associated Herpesvirus (KSHV) among people with 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 three 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 post-transplant 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) 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 0.26-1.52): 3 skin-only KS, 1 multicentric Castleman disease, 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.

Keywords: HHV8 seroprevalence; HIV; HOPE Act; Human Herpesvirus 8; KSHV seroprevalence; Kaposi Sarcoma; organ transplantation.

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