Use of raltegravir in HIV-positive transplant recipients

Tricot and colleagues performed a retrospective review of the outcomes of 13 HIV-infected transplant patients treated with a raltegravir (RAL) and two nucleoside reverse transcriptase inhibitor (NRTI) regimen. Tolerability, ARV efficacy (plasma viral load, CD4 cell count), drug interactions, raltegravir pharmacokinetics and transplant outcome were assessed.

Thirteen patients with liver (n=8) or kidney (n=5) transplantation were included. RAL was initiated (400 mg twice daily) either at time of transplantation (n=6), or after transplantation (n=7). Median raltegravir trough concentration was 507 ng/ml (range, 176-890), which is above the in vitro IC95 for wild type HIV-1 strains (15 ng/ml). Target trough levels of tacrolimus or ciclosporin were obtained with standard doses. There were no episodes of acute rejection and HIV infection remained controlled. After a median follow-up of 9 months (range, 6-14), all patients were alive with satisfactory graft function.

There was no evidence of an interaction between raltegravir and the immunosuppressants, and therefore, the use of a raltegravir + two NRTI-based regimen is a good alternative in HIV-infected patients undergoing solid organ transplantation.

TricotLetal.SafetyandefficacyofraltegravirinHIV-infectedtransplantpatientscotreatedwithimmunosuppressivedrugs.AmJTransplantation,Tricot L et al. Safety and efficacy of raltegravir in HIV-infected transplant patients cotreated with immunosuppressive drugs. Am J Transplantation, 2009, 9:1-7.
http://www.ncbi.nlm.nih.gov/pubmed/19519819