Background:Renal transplantation has become a more common occurrence in HIV-infected individuals. The post-transplant antiretroviral regimen is one of the challenges in this population due to drug interactions with common immunosuppressive agents. Regimens containing protease inhibitors (PI) pose a challenge post-transplant, leading to altered calcineurin inhibitor (CNI) dosing and the potential for increased CNI exposure. This has led to increased utilization of newer agents that lack significant interactions with CNI. The purpose of this study was to examine the impact of PI-based regimens on graft outcomes in HIV-infected renal transplant recipients.
Methods:Retrospective study of renal allograft recipients transplanted between 2003 and 2015 with ≥6 months of follow-up. Maintenance immunosuppressive medications included CNI+ mycophenolic acid ± steroids.
Results:During this period, our center performed 50 renal transplants in HIV-infected recipients. Twenty-six patients (52%) received a PI based regimen and 24 patients (48%) received a non-PI based regimen. There were no significant differences between groups in terms of age, race, gender, or cause of CKD. The majority of patients in each group received deceased donor renal transplants, and greater than 50% of patients in each group experienced delayed graft function. Significantly more patients in the non-PI group received induction with T-cell depleting agents. The cumulative rejection rate in both groups was 64%. The estimated GFR did not differ between groups at time points evaluated (30 days to 4 years post-transplant). At last follow-up, patient and graft survival was 92% vs. 83% and 81% vs. 58% in the PI and non-PI groups, respectively.
Conclusions:HIV-infected renal transplant recipients experienced high rates of rejection regardless of antiretroviral regimen. However, PI-based ARV regimens appear to be associated with better graft survival, suggesting that converting patients to non-PI regimens may not be warranted.
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