Dolutegravir-Based Antiretroviral Regimens for HIV Liver Transplant Patients in Real-Life Settings.

Abstract

BACKGROUND AND OBJECTIVES:

Liver transplantation is now considered a safe procedure in patients with HIV because of the advent of potent antiretroviral therapies (ART).

OBJECTIVE:

We aimed to describe the use of dolutegravir-based maintenance ART in patients with HIV and liver transplant regularly followed in our hospital.

METHODS:

We searched the database of our Department of Infectious Diseases for liver transplant recipients receiving calcineurin inhibitor-based maintenance immunosuppression concomitantly treated with dolutegravir for at least 1 month.

RESULTS:

Ten HIV-positive liver transplant recipients were identified. At 4.6 ± 3.5 years post-transplant, all the patients were switched to dolutegravir-based therapies for treatment simplification. However, at 1 year after the switch, five of the ten patients returned to their previous ART regimens because of increased serum transaminases (n = 1), reversible increased serum creatinine (n = 4), repeated episodes of nausea/vomiting (n = 1) and variable out-of-range concentrations of tacrolimus or cyclosporine (n = 2). However, it should be recognized that these events cannot be unequivocally ascribed to dolutegravir and, in the case of increased serum creatinine, are predictable.

CONCLUSIONS:

The management of HIV-positive liver transplant recipients in clinical practice is a complex task, where possibility of simplifying antiretroviral regimens must be balanced with the need to guarantee optimal immunosuppression and the finest treatment tolerability. A multidisciplinary approach involving physicians and clinical pharmacologists/pharmacists could help achieve this goal.

• Authors: Dario Cattaneo, Salvatore Sollima, Paola Meraviglia, Laura Milazzo, Davide Minisci, Marta Fusi, Carlo Filice, Cristina Gervasoni
• Journal: Drugs in R&D (Drugs R D) Vol. 20 Issue 2 Pg. 155-160 (Jun 2020) ISSN: 1179-6901 [Electronic] New Zealand
• PMID: 32189238 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents
• HIV Integrase Inhibitors
• Heterocyclic Compounds, 3-Ring
• Oxazines
• Piperazines
• Pyridones
• dolutegravir

Topics

• Anti-HIV Agents (therapeutic use)
• Female
• HIV Infections (drug therapy)
• HIV Integrase Inhibitors (therapeutic use)
• Heterocyclic Compounds, 3-Ring (therapeutic use)
• Humans
• Liver Transplantation
• Male
• Middle Aged
• Oxazines (therapeutic use)
• Piperazines (therapeutic use)
• Pyridones (therapeutic use)
• Retrospective Studies