Antiretroviral Therapy Combo Pills in HIV<sup>+</sup> Kidney Transplant Recipients: First Do No Harm

Camargo, José F.; Chin‐Beckford, Nafeesa

doi:10.1177/1060028017692601

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…34 Several cases of significantly elevated tacrolimus concentrations and toxicity have been reported in HIV-infected renal transplant patients following coadministration of elvitegravir/cobicistat and tacrolimus. [35][36][37] Extensive bruising and elevated rivaroxaban concentrations were observed in a patient on elvitegravir/ cobicistat, 38 and severe acute leg ischemia occurred following ingestion of an ergotamine-containing preparation by a patient on elvitegravir/cobicistat. 39 Of note, whereas ergot alkaloids, fluticasone, and tacrolimus are mentioned in the product monographs for elvitegravir/cobicistat, vinblastine and rivaroxaban are not.…”

Section: Cyp3a4 Substratesmentioning

confidence: 99%

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Tseng

Hughes

et al. 2017

Ann Pharmacother

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Objective: To describe properties of cobicistat and ritonavir; compare boosting data with atazanavir, darunavir, and elvitegravir; and summarize antiretroviral and comedication interaction studies, with a focus on similarities and differences between ritonavir and cobicistat. Considerations when switching from one booster to another are discussed. Data Sources: A literature search of MEDLINE was performed (1985 to April 2017) using the following search terms: cobicistat, ritonavir, pharmacokinetic, drug interactions, booster, pharmacokinetic enhancer, HIV, antiretrovirals. Abstracts from conferences, article bibliographies, and product monographs were reviewed. Study Selection and Data Extraction: Relevant English-language studies or those conducted in humans were considered. Data Synthesis: Similar exposures of elvitegravir, darunavir, and atazanavir are achieved when combined with cobicistat or ritonavir. Cobicistat may not be as potent a CYP3A4 inhibitor as ritonavir in the presence of a concomitant inducer. Ritonavir induces CYP1A2, 2B6, 2C9, 2C19, and uridine 5′-diphospho-glucuronosyltransferase, whereas cobicistat does not. Therefore, recommendations for cobicistat with comedications that are extrapolated from studies using ritonavir may not be valid. Pharmacokinetic properties of the boosted antiretroviral can also affect interaction outcome with comedications. Problems can arise when switching patients from ritonavir to cobicistat regimens, particularly with medications that have a narrow therapeutic index such as warfarin. Conclusions: When assessing and managing potential interactions with ritonavir- or cobicistat-based regimens, clinicians need to be aware of important differences and distinctions between these agents. This is especially important for patients with multiple comorbidities and concomitant medications. Additional monitoring or medication dose adjustments may be needed when switching from one booster to another.

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Section: Cyp3a4 Substratesmentioning

confidence: 99%

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Tseng

Hughes

et al. 2017

Ann Pharmacother

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Pharmacotherapeutic management of HIV in transplant patients

Spagnuolo

Uberti-Foppa

Castagna

2019

Expert Opinion on Pharmacotherapy

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Impact of Protease Inhibitor–Based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients

Sawinski

Shelton

Mehta

et al. 2017

American Journal of Transplantation

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Excellent outcomes have been demonstrated among select HIV-positive kidney transplant (KT) recipients with well-controlled infection, but to date, no national study has explored outcomes among HIV+ KT recipients by antiretroviral therapy (ART) regimen. Intercontinental Marketing Services (IMS) pharmacy fills (1/1/01-10/1/12) were linked with Scientific Registry of Transplant Recipients (SRTR) data. A total of 332 recipients with pre- and posttransplantation fills were characterized by ART at the time of transplantation as protease inhibitor (PI) or non-PI-based ART (88 PI vs. 244 non-PI). Cox proportional hazards models were adjusted for recipient and donor characteristics. Comparing recipients by ART regimen, there were no significant differences in age, race, or HCV status. Recipients on PI-based regimens were significantly more likely to have an Estimated Post Transplant Survival (EPTS) score of >20% (70.9% vs. 56.3%, p = 0.02) than those on non-PI regimens. On adjusted analyses, PI-based regimens were associated with a 1.8-fold increased risk of allograft loss (adjusted hazard ratio [aHR] 1.84, 95% confidence interval [CI] 1.22-2.77, p = 0.003), with the greatest risk observed in the first posttransplantation year (aHR 4.48, 95% CI 1.75-11.48, p = 0.002), and a 1.9-fold increased risk of death as compared to non-PI regimens (aHR 1.91, 95% CI 1.02-3.59, p = 0.05). These results suggest that whenever possible, recipients should be converted to a non-PI regimen prior to kidney transplantation.

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Antiretroviral Therapy Combo Pills in HIV⁺ Kidney Transplant Recipients: First Do No Harm

Abstract: The goal of this letter is to promote awareness among prescribers of potential drug-drug interactions between antiretroviral therapy (ART) and immunosuppressant agents commonly used in transplantation. RM underwent a

Cited by 3 publications

References 6 publications

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Pharmacotherapeutic management of HIV in transplant patients

Impact of Protease Inhibitor–Based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients

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Antiretroviral Therapy Combo Pills in HIV+ Kidney Transplant Recipients: First Do No Harm

Abstract: The goal of this letter is to promote awareness among prescribers of potential drug-drug interactions between antiretroviral therapy (ART) and immunosuppressant agents commonly used in transplantation. RM underwent a

Cited by 3 publications

References 6 publications

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Cobicistat Versus Ritonavir: Similar Pharmacokinetic Enhancers But Some Important Differences

Pharmacotherapeutic management of HIV in transplant patients

Impact of Protease Inhibitor–Based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients

Contact Info

Product

Resources

About

Antiretroviral Therapy Combo Pills in HIV⁺ Kidney Transplant Recipients: First Do No Harm