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

Year: 2025

Type: article

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.

Source: Clinical Infectious Diseases

DOI: 10.1093/cid/ciaf229

Institutions: Memorial Sloan Kettering Cancer Center, Johns Hopkins University, Johns Hopkins Medicine, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. (United States), Ochsner Health System, Ochsner Medical Center, University of Pennsylvania, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, University of Miami, University of California, Los Angeles, Emory University, University of California, San Francisco, Northwestern University, University of Alabama at Birmingham, NYU Langone Health, New York University, Georgetown University, Massachusetts General Hospital, Weill Cornell Medicine, University of Pittsburgh, Yale University, Columbia University Irving Medical Center, University of California San Diego, The University of Texas Southwestern Medical Center, Rush University Medical Center, University of Cincinnati, Drexel University, National Institutes of Health, National Institute of Allergy and Infectious Diseases

Language: English

Topic: Viral-associated cancers and disorders

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: U.S. Department of Health and Human Services, Johns Hopkins University, National Institutes of Health, Center for AIDS Research, University of Washington, Center for AIDS Research, Johns Hopkins University, National Cancer Institute, National Institute of Allergy and Infectious Diseases

Awards: G2131554273, G2483435703, G4414436704, G653582874, G7178514535, G9000038650, G9000088037, G9000105291, G9000121584, G9000266597, Expanding HOPE Liver Transplantation: Understanding Opportunistic Infection and Cancer Risk, Cancer Center Support Grant, Leveraging a novel health records platform to predict the development of cardiovascular disease following kidney transplantation, The Johns Hopkins Center for AIDS Research (JHU CFAR)

OpenAlex ID: W4410082743