Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV + kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV - to HIV + adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% ( p=0.06) and 82% vs. 100% ( p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV + kidney transplant recipients.

Original languageEnglish (US)
Article number2893
JournalF1000Research
Volume5
DOIs
StatePublished - 2016

Fingerprint

Transplants
Protease Inhibitors
HIV
Kidney
Grafts
Graft Survival
Therapeutics
Drug interactions
Integrases
Biopsy
Immunosuppressive Agents
Transplant Recipients
Survival
Incidence
Infection
Drug Interactions
Cohort Studies
Retrospective Studies
Transplantation
Pharmaceutical Preparations

Keywords

  • Antiretroviral therapy
  • HIV
  • Infection
  • Kidney transplant
  • Protease inhibitor

ASJC Scopus subject areas

  • Medicine(all)
  • Immunology and Microbiology(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

@article{a4465e3bc1b24bcc8b015f1e695ba109,
title = "Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases",
abstract = "Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV + kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV - to HIV + adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90{\%} for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85{\%} vs. 100{\%} ( p=0.06) and 82{\%} vs. 100{\%} ( p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95{\%} confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100{\%}, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8{\%}, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV + kidney transplant recipients.",
keywords = "Antiretroviral therapy, HIV, Infection, Kidney transplant, Protease inhibitor",
author = "{Camargo Galvis}, Jose and Rossana Rosa and Suarez, {Jose F.} and Lorio, {Marco A.} and Morris, {Michele I} and Lilian Abbo and Jacques Simkins-Cohen and Giselle Guerra and David Roth and Warren Kupin and Mattiazzi, {Adela D} and Gaetano Ciancio and Chen, {Linda J} and Burke, {George W} and Figueiro, {Jose M.} and Phillip Ruiz",
year = "2016",
doi = "10.12688/f1000research.10414.1",
language = "English (US)",
volume = "5",
journal = "F1000Research",
issn = "2046-1402",
publisher = "F1000 Research Ltd.",

}

TY - JOUR

T1 - Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients

T2 - Review of 58 cases

AU - Camargo Galvis, Jose

AU - Rosa, Rossana

AU - Suarez, Jose F.

AU - Lorio, Marco A.

AU - Morris, Michele I

AU - Abbo, Lilian

AU - Simkins-Cohen, Jacques

AU - Guerra, Giselle

AU - Roth, David

AU - Kupin, Warren

AU - Mattiazzi, Adela D

AU - Ciancio, Gaetano

AU - Chen, Linda J

AU - Burke, George W

AU - Figueiro, Jose M.

AU - Ruiz, Phillip

PY - 2016

Y1 - 2016

N2 - Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV + kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV - to HIV + adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% ( p=0.06) and 82% vs. 100% ( p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV + kidney transplant recipients.

AB - Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV + kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV - to HIV + adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% ( p=0.06) and 82% vs. 100% ( p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV + kidney transplant recipients.

KW - Antiretroviral therapy

KW - HIV

KW - Infection

KW - Kidney transplant

KW - Protease inhibitor

UR - http://www.scopus.com/inward/record.url?scp=85015232189&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015232189&partnerID=8YFLogxK

U2 - 10.12688/f1000research.10414.1

DO - 10.12688/f1000research.10414.1

M3 - Article

AN - SCOPUS:85015232189

VL - 5

JO - F1000Research

JF - F1000Research

SN - 2046-1402

M1 - 2893

ER -