Document Detail


Drug-Drug Interactions Between Antiretroviral and Immunosuppressive Agents in HIV-Infected Patients After Solid Organ Transplantation: A Review.
MedLine Citation:
PMID:  23025916     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Abstract Since the introduction of combination antiretroviral therapy (cART) resulting in the prolonged survival of HIV-infected patients, HIV infection is no longer considered to be a contraindication for solid organ transplantation (SOT). The combined management of antiretroviral and immunosuppressive therapy proved to be extremely challenging, as witnessed by high rates of allograft rejection and drug toxicity, but the profound drug-drug interactions between immunosuppressants and cART, especially protease inhibitors (PIs) also play an important role. Caution and frequent drug level monitoring of calcineurin inhibitors, such as tacrolimus are necessary when PIs are (re)introduced or withdrawn in HIV-infected recipients. Furthermore, the pharmacokinetics of glucocorticoids and mTOR inhibitors are seriously affected by PIs. With the introduction of integrase inhibitors, CCR5-antagonists and fusion inhibitors which cause significantly less pharmacokinetic interactions, have minor overlapping toxicity, and offer the advantage of pharmacodynamic synergy, it is time to revaluate what may be considered the optimal antiretroviral regimen in SOT recipients. In this review we provide a brief overview of the recent success of SOT in the HIV population, and an update on the pharmacokinetic and pharmacodynamic interactions between currently available cART and immunosuppressants in HIV-infected patients, who underwent SOT.
Authors:
Erik M van Maarseveen; Christin C Rogers; Jennifer Trofe-Clark; Arjan D van Zuilen; Tania Mudrikova
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AIDS patient care and STDs     Volume:  26     ISSN:  1557-7449     ISO Abbreviation:  AIDS Patient Care STDS     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607225     Medline TA:  AIDS Patient Care STDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  568-81     Citation Subset:  IM; X    
Affiliation:
1 Department of Clinical Pharmacy, University Medical Center Utrecht , The Netherlands .
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