Impact of antiretroviral regimen on renal transplant outcomes in HIV‐infected recipients

Sparkes, Tracy; Manitpisitkul, Wana; Masters, B.; Bartlett, Stephen T.; Davis, Charles E.; Husson, Jennifer; Amoroso, Anthony; Haririan, Abdolreza

doi:10.1111/tid.12992

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…At these time points, rejection rates were significantly higher with boosted PI ART regimens compared to other HAART regimens, 59% vs 24%. Drug interaction and impact on rejection 24 Report on 50 patients where cumulative rejection rates at 12 and 36 mo were 41% and 54% in the PI group vs 52% and 86% in the non-PI group. At last follow-up, the overall risk of acute rejection in the PI group was 46% lower compared with the non-PI cohort.…”

Section: Drug Interactions and Its Impactmentioning

confidence: 99%

Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies

Muller

Botha²,

Barday

et al. 2020

Transplantation

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The spectrum of renal pathology in HIV-positive individuals is diverse, including lesions directly related to intrarenal HIV gene expression and lesions related to comorbidities, ReviewBackground. HIV-positive patients had been successfully transplanted for the last 15 y and the donor pool had successfully been expanded to also include HIV-positive donors. Methods. We aimed to evaluate the effectiveness of transplantation in HIV-positive patients and highlight some of the important issues reported in the literature. We pooled clinical data from different cohorts to show some of the common issues encountered in HIV-positive transplantation. Furthermore, we searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL to create a comprehensive table for current evidence for different issues currently encountered when transplanting HIV-positive patients. Results. We included data from 19 cohort studies and reported on outcomes of the current HIV-positive transplant programs. We made recommendations based on personal experience as well as the experience reported in the literature regarding rejection, opportunistic infection, and HIV-associated nephropathy. Opportunistic infections and malignancies are not a major problem for this population group. Conclusions. HIV-positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. When utilizing HIV-positive donors, the recurrence of HIV-associated nephropathy in the graft kidney is an issue which can be important. Despite some issues with high rejection rates, HIV-positive patients have similar results to HIV-negative patients posttransplantation.

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Section: Drug Interactions and Its Impactmentioning

confidence: 99%

Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies

Muller

Botha²,

Barday

et al. 2020

Transplantation

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“…However, use of these agents comes with the risk of adverse effects of immunosuppression (including significant nephrotoxicity and neurotoxicity) and rejection due to potentially subtherapeutic levels while in the dose‐finding stages, as well as difficulty with patient compliance . Encouragingly, Sparkes, et al recently reported data showing reduced renal graft failure rates with PI use at their transplant center . Further research into the close monitoring of tacrolimus in this setting is warranted.…”

Section: Discussionmentioning

confidence: 99%

Successful optimization of antiretroviral regimens in treatment‐experienced people living with HIV undergoing liver transplantation

Waldman

Rawlings

Kerr

et al. 2019

Transplant Infectious Dis

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Modern antiretroviral therapy (ART) extends life expectancy for people living with HIV (PLWH). However, most older PLWH (≥50 years) “aged” with HIV and were exposed to historical HIV care practices and older, more toxic ART. In PLWH with exposure to older and multiple ART regimens, the drug interactions between ART frequently used in treatment‐experienced persons and commonly used immunosuppressants remain a significant challenge. However, the advent of newer ART classes (eg, integrase non‐strand transfer inhibitors) and more advanced HIV genetic resistance testing may allow optimization of ART regimens with minimal drug interactions. Here, we present a case series of three PLWH whose complicated ART interacted (or was at risk for interacting) with their post–liver transplant immunosuppression. After a review of their proviral DNA resistance testing, they successfully transitioned onto safer integrase non‐strand transfer inhibitor‐containing ART regimens without viral blips or evidence of organ rejection.

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“…Rejection rates were noted to be significantly higher with PI‐boosted regimens at 1, 2, and 3 years (59%‐68%) in a single‐center retrospective study from Rollins and colleagues of 42 HIV+ kidney transplant recipients 34 . In contrast, Sparkes' retrospective cohort study of 50 HIV+ kidney transplant recipients showed lower rejection rates at 1 year in the PI‐based regimen group (41% vs. 52%) 35 . Additionally, PI‐based regimens have been associated with an increased risk of patient death (aHR 1.91, 95% CI 1.02‐3.59) and allograft loss (aHR 1.84, 95% CI 1.22‐2.77) 36 .…”

Section: Hiv and Eskdmentioning

confidence: 95%

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

Sawinski

Wong

Goral

2020

Clinical Transplantation

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Human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common chronic viral infections in the end‐stage kidney disease (ESKD) patient population that were once considered relative contraindications to kidney transplantation. In this review, we will summarize the current state of kidney transplantation in patients with HIV, HCV, and HBV, which is rapidly evolving. HIV+ patients enjoy excellent outcomes in the modern transplant era and may have new transplant opportunities with the use of HIV+ donors. Direct‐acting antivirals for HCV have substantially changed the landscape of care for patients with HCV infection. HBV+ patients now have excellent patient and allograft survival with HBV therapy. Currently, kidney transplantation is a safe and appropriate treatment for the majority of ESKD patients with HIV, HCV, and HBV.

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Impact of antiretroviral regimen on renal transplant outcomes in HIV‐infected recipients

Cited by 11 publications

References 30 publications

Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies

Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies

Successful optimization of antiretroviral regimens in treatment‐experienced people living with HIV undergoing liver transplantation

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

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