TY - JOUR
T1 - Impact of Protease Inhibitor-Based Antiretroviral Therapy on Tacrolimus Intrapatient Variability in HIV-Positive Kidney Transplant Recipients
AU - Cooper, Megan
AU - Dunne, Ian
AU - Kuten, Samantha
AU - Curtis, Anna
AU - Graviss, Edward A.
AU - Nguyen, Duc T.
AU - Hobeika, Mark
AU - Gaber, A. Osama
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Human immunodeficiency virus (HIV)-positive kidney transplant (KT) recipients have been shown to experience higher rejection rates due in part to drug-drug interactions between antiretroviral therapy (ART) and immunosuppression regimens. High tacrolimus (FK) intrapatient variability (IPV) is associated with inferior outcomes in KT. The purpose of this study was to determine the impact of protease inhibitor (PI)-based ART on FK IPV and graft outcomes. Methods: We performed a single-center review of HIV-positive KT recipients from 2007 to 2017. Percentage coefficient of variation (%CV = (σ/μ) × 100; σ, median; μ, standard deviation) was calculated for FK IPV. FK IPV at 6 and 12 months, graft function, and immune outcomes in PI-based vs non-PI-based KT recipients were compared. Results: A total of 23 HIV-positive KT patients were identified, of whom 10 were maintained on PI-based ART. Median IPV for the entire cohort at 6 and 12 months was 35.8% and 41%, respectively. Patients on PI-based regimens were proportionally more likely to experience high IPV at both time points. Median FK IPV was numerically higher at 6 months (37.3% vs 26.8%, P = .11) and significantly higher at 12 months (57.8% vs 30.9%, P = .01) for patients on PI-based regimens. Lastly, inferior graft function was observed in PI-based patients. Conclusion: Our data suggest that PI-based ART is associated with a higher degree of FK IPV, which may contribute to worsening graft function. Larger studies are warranted to determine the impact of PI-based ART on FK IPV and graft outcomes in this population.
AB - Background: Human immunodeficiency virus (HIV)-positive kidney transplant (KT) recipients have been shown to experience higher rejection rates due in part to drug-drug interactions between antiretroviral therapy (ART) and immunosuppression regimens. High tacrolimus (FK) intrapatient variability (IPV) is associated with inferior outcomes in KT. The purpose of this study was to determine the impact of protease inhibitor (PI)-based ART on FK IPV and graft outcomes. Methods: We performed a single-center review of HIV-positive KT recipients from 2007 to 2017. Percentage coefficient of variation (%CV = (σ/μ) × 100; σ, median; μ, standard deviation) was calculated for FK IPV. FK IPV at 6 and 12 months, graft function, and immune outcomes in PI-based vs non-PI-based KT recipients were compared. Results: A total of 23 HIV-positive KT patients were identified, of whom 10 were maintained on PI-based ART. Median IPV for the entire cohort at 6 and 12 months was 35.8% and 41%, respectively. Patients on PI-based regimens were proportionally more likely to experience high IPV at both time points. Median FK IPV was numerically higher at 6 months (37.3% vs 26.8%, P = .11) and significantly higher at 12 months (57.8% vs 30.9%, P = .01) for patients on PI-based regimens. Lastly, inferior graft function was observed in PI-based patients. Conclusion: Our data suggest that PI-based ART is associated with a higher degree of FK IPV, which may contribute to worsening graft function. Larger studies are warranted to determine the impact of PI-based ART on FK IPV and graft outcomes in this population.
KW - Adult
KW - Cohort Studies
KW - Drug Interactions
KW - Female
KW - Graft Rejection/immunology
KW - HIV Infections/complications
KW - HIV Protease Inhibitors/therapeutic use
KW - Humans
KW - Immunosuppression Therapy/methods
KW - Immunosuppressive Agents/blood
KW - Kidney Transplantation
KW - Male
KW - Middle Aged
KW - Retrospective Studies
KW - Tacrolimus/blood
KW - Transplant Recipients
UR - http://www.scopus.com/inward/record.url?scp=85096871310&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85096871310&partnerID=8YFLogxK
U2 - 10.1016/j.transproceed.2020.10.003
DO - 10.1016/j.transproceed.2020.10.003
M3 - Article
C2 - 33246588
AN - SCOPUS:85096871310
SN - 0041-1345
VL - 53
SP - 984
EP - 988
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 3
ER -