BI08 Spectrum of mucocutaneous disorders in organ transplant recipients living with HIV: insights from the international MOTH study

Abstract

People living with HIV who are solid organ transplantation recipients (OTRs) represent a growing but understudied population. The burden of dermatological disease resulting from this dual immunosuppressive state remains poorly defined, with no established surveillance guidelines. The MOTH study (Mucocutaneous diseases in Organ Transplant recipients living with HIV) aimed to characterize the spectrum of mucocutaneous disease in OTRs living with HIV to inform future screening and surveillance strategies. We conducted an international, multicentre cross-sectional study. Participating centres identified OTRs living with HIV and collected retrospective clinicopathological data on HIV status, transplant characteristics and mucocutaneous disease identified on total-body skin examination (TBSE). Individuals without a documented TBSE, including anogenital examination, within the previous 6 months were either invited for review or excluded from analysis. In total 230 patients from 12 centres were included (161 male and 69 female; mean age 59.4 years, SD 9.2). The most ethnic group was Black African (53.2%), followed by White (31.6%) and Other ethnicities (14.7%). Kidney transplantation was most common (65.4%), followed by liver (22.9%). Viral infections were the most prevalent dermatological condition, affecting 65.5% of patients, most commonly benign human papillomavirus (HPV) infection (27.7%), followed by herpes simplex virus (19.5%), premalignant or malignant HPV (17.8%) and other viral infections (9.1%). Nearly one-quarter of patients had more than one viral infection. Anogenital HPV accounted for over half of HPV infections and affected 14.3% of the total cohort. Skin cancer was identified in 8.2% of patients, including squamous cell carcinoma, basal cell carcinoma, Kaposi sarcoma and melanoma. This study highlights a substantial burden of mucocutaneous disease in OTRs living with HIV, particularly anogenital and HPV-related disease. These findings underscore the need for routine anogenital examination, enhanced dermatological surveillance and preventive strategies, including vaccination. A prospective, case–control study to better understand the burden and relevant risk factors in this population is now in development.