Bictegravir/emtricitabine/tenofovir alafenamide combination in the management of kidney transplant patients with HIV receiving immunosuppressants

• Published in: Journal of chemotherapy (Florence) 2022-05, Vol.34 (3), p.199-202
• Main Authors: Lagoutte-Renosi, Jennifer, Flammang, Mylène, Ducloux, Didier, Bamoulid, Jamal, Royer, Pierre-Yves, Lepiller, Quentin, Clairet, Anne-Laure, Davani, Siamak, Muret, Patrice
• Format: Article
• Language: English
• Subjects: Adenine; Alanine; Amides; Anti-HIV Agents - therapeutic use; Drug Combinations; Emtricitabine - therapeutic use; Heterocyclic Compounds, 3-Ring; Heterocyclic Compounds, 4 or More Rings - therapeutic use; HIV Infections - drug therapy; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation; Piperazines; Protease Inhibitors - therapeutic use; Pyridones; Tacrolimus - therapeutic use; Tenofovir - analogs & derivatives
• ISSN: 1120-009X; 1973-9478
• DOI: 10.1080/1120009X.2021.1940436

We report here a drug-drug interaction with tacrolimus in a HIV-positive patient with renal transplant, after switch from highly active antiretroviral therapy with boosted protease inhibitors to the combination bictegravir/emtricitabine/tenofovir alafenamide. Although the tacrolimus doses were adapted to take account of the pharmacokinetic interactions with protease inhibitors, a tacrolimus overdosage occurred in the patient nonetheless. Through this case report, we highlight the need to consider a sufficient timeframe of withdrawal of protease inhibitors, which induce a prolonged drug-drug interaction with tacrolimus. To conclude, we purport that the combination bictegravir/emtricitabine/tenofovir alafenamide could be an attractive alternative in the context of transplantation provided a discontinuation of boosted protease inhibitors for more than 48 hours before introducing tacrolimus.