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The Landscape of Serious Infections following Kidney Transplantation in People Living with HIV

Award Number: K23AI157893
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 08/19/2021
PERIOD OF PERFORMANCE END DATE: 07/31/2026

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The Landscape of Serious Infections following Kidney Transplantation in People Living with HIV - Project Summary/Abstract Kidney transplantation (KT) is a lifesaving intervention for the 10,000 people living with HIV (PLWH) and end- stage renal disease in the United States. Confirmed as safe and effective in the early 2000s, this practice has rapidly expanded in the past decade amid transformative antiviral advances for HIV and hepatitis C (HCV) as well as passage of the HIV Organ Policy Equity (HOPE) Act permitting HIV-to-HIV transplantation. Despite the complex nature of this vulnerable population, neither the landscape of serious infections nor an understanding of optimal immunosuppression to balance infection and kidney rejection risk has been defined. It is critical to understand this paradigm as infection causes >20% of early deaths following KT and rejection, which results in immunosuppressive intensification and a more susceptible host, is 2-4-fold more common in HIV+ KT recipients. The goals of this proposal include characterizing the burden, timing, and spectrum of serious infections after HIV+ KT with comparison to matched HIV- KT recipients to understand differential risks associated with recipient HIV status (Aim 1). This will be accomplished through development of the largest cohort of HIV+ KT recipients to date by linking the Scientific Registry of Transplant Recipients and the US Renal Data System, which also incorporates Centers for Medicare and Medicaid claims data to ascertain serious infection events. Pharmacy clearinghouse data will augment infection, rejection, and antimicrobial prophylaxis ascertainment. Next, among the population of HIV+ KT recipients, a risk factor analysis will be performed with focus on biological variables and immunosuppressive regimens associated with developing serious post-transplant infections (Aim 2). The goal of this analysis is to inform targeted monitoring and prophylaxis to prevent infectious complications in HIV+ KT recipients. Finally, the association of donor HIV status with serious infection risk will be explored through the robust infrastructure of the ongoing HOPE in Action multicenter clinical trials of HIV-to-HIV KT (NCT03500315, Aim 3). This analysis will incorporate rich data on HIV+ organ donors and recipients including hitherto unexplored HIV biology and laboratory markers, in the context of robust infection and rejection reporting. Taken together, this proposal seeks to delineate the landscape of serious infection among PLWH undergoing KT in the modern era using a comprehensive infection ascertainment schema and rigorous epidemiologic methods. Ultimately, the goal is to advance understanding of infectious complications in this unique and emerging group and drive evidence-based practices that improve long-term post-KT outcomes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $121,302 )
2025	2025	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	001	5	7/31/2025	NON-COMPETING CONTINUATION	$129,187
2025	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	000	4	6/5/2025	NON-COMPETING CONTINUATION	-$7,885
														Subtotal = $121,302

Issue Date FY: 2024 ( Subtotal = $176,503 )
2024	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	000	4	6/24/2024	NON-COMPETING CONTINUATION	$176,503
														Subtotal = $176,503

Issue Date FY: 2023 ( Subtotal = $183,440 )
2023	2023	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	000	3	8/1/2023	NON-COMPETING CONTINUATION	$183,440
														Subtotal = $183,440

Issue Date FY: 2022 ( Subtotal = $180,848 )
2022	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	000	2	7/8/2022	NON-COMPETING CONTINUATION	$180,848
														Subtotal = $180,848

Issue Date FY: 2021 ( Subtotal = $184,515 )
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Allergy and Infectious Diseases Research	000	1	8/19/2021	NEW	$184,515
														Subtotal = $184,515

Grand Total All Awards = $846,608

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The Landscape of Serious Infections following Kidney Transplantation in People Living with HIV

Award Number: K23AI157893

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 08/19/2021

PERIOD OF PERFORMANCE END DATE: 07/31/2026

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