Assistance Publique-Hôpitaux de Paris.
Safety and Efficacy of Raltegravir in HIV-Infected Transplant Patients Cotreated with Immunosuppressive Drugs
Version of Record online: 10 JUN 2009
© 2009 The Authors Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 9, Issue 8, pages 1946–1952, August 2009
How to Cite
Tricot, L., Teicher, E., Peytavin, G., Zucman, D., Conti, F., Calmus, Y., Barrou, B., Duvivier, C., Fontaine, C., Welker, Y., Billy, C., De Truchis, P., Delahousse, M., Vittecoq, D. and Salmon-Céron, D. (2009), Safety and Efficacy of Raltegravir in HIV-Infected Transplant Patients Cotreated with Immunosuppressive Drugs. American Journal of Transplantation, 9: 1946–1952. doi: 10.1111/j.1600-6143.2009.02684.x
- Issue online: 16 JUL 2009
- Version of Record online: 10 JUN 2009
- Received 02 November 2008, revised 19 March 2009 and accepted for publication 07 April 2009
- Drug interaction;
- drug monitoring;
- HAART toxicity;
- HIV infection
Solid organ transplantations (SOT) are performed successfully in selected HIV-infected patients. However, multiple and reciprocal drug–drug interactions are observed between antiretroviral (ARV) drugs and calcineurin inhibitors (CNIs) through CYP450 metabolization. Raltegravir (RAL), a novel HIV-1 integrase inhibitor, is not a substrate of CYP450 enzymes. We retrospectively reviewed the outcomes of 13 HIV-infected transplant patients treated by an RAL + two nucleosidic reverse transcriptase inhibitor (NRTI) regimen, in terms of tolerability, ARV efficacy (plasma viral load, CD4 cell count), drug interactions, RAL pharmacokinetics and transplant outcome. Thirteen patients with liver (n = 8) or kidney (n = 5) transplantation were included. RAL was initiated (400 mg BID) either at time of transplantation (n = 6), or after transplantation (n = 7). Median RAL trough concentration was 507 ng/mL (176–890), which is above the in vitro IC95 for wild type HIV-1 strains (15 ng/mL). Target trough levels of CNIs were promptly obtained with standard dosages of tacrolimus or cyclosporine. RAL tolerability was excellent. There was no episode of acute rejection. HIV infection remained controlled. After a median follow-up of 9 months (range: 6–14), all patients were alive with satisfactory graft function. The use of an RAL + two NRTI-based regimen is a good alternative in HIV-infected patients undergoing SOT.