Drug interaction after ritonavir discontinuation: considerations for antiretroviral therapy changes in renal transplant recipients

Organ transplantation among people living with human immunodeficiency virus (PLHIV) is increasing. Guidelines recommend any changes in antiretroviral therapy (ART) prior to transplantation, but there are limited data regarding ART changes post transplantation. We report a case where an ART switch fr...

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Bibliographic Details
Published in:International journal of STD & AIDS 2019-06, Vol.30 (7), p.710-714
Main Authors: Jimenez, Humberto R, Natali, Kayla M, Zahran, Ali Abdel Rahman
Format: Article
Language:English
Subjects:
AIDS/HIV
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Summary:Organ transplantation among people living with human immunodeficiency virus (PLHIV) is increasing. Guidelines recommend any changes in antiretroviral therapy (ART) prior to transplantation, but there are limited data regarding ART changes post transplantation. We report a case where an ART switch from a protease inhibitor-based regimen to dolutegravir plus emtricitabine/tenofovir alafenamide in a renal transplant recipient led to subtherapeutic tacrolimus concentrations and an increased serum creatinine (SCr). A workup for graft rejection was performed (including kidney biopsy and cytomegalovirus and BK virus polymerase chain reaction) following the rise in SCr, which was higher than expected from dolutegravir initiation (via organ cation transporter 2 inhibition). This case highlights the potential challenges of switching ART regimens in PLHIV post transplantation.
ISSN:0956-4624
1758-1052
DOI:10.1177/0956462419829989