Background: One-year rejection rates in HIV-infected kidney transplant recipients range from 15-40%, compared to overall rejection rates of 10% in HIV-negative patients. Protocols for immunosuppression and highly active antiretroviral therapy (HAART) regimens in this population vary substantially among transplant programs. The potential for significant drug-drug interactions, specifically between ritonavir-boosted protease inhibitors (rtv+ PI) and calcineurin inhibitors, and the choice of induction therapy may influence outcomes.

Methods: This is an IRB-approved, single center, retrospective study of adult HIV-infected patients with a kidney transplant performed between 5/2009 to 8/2014 with one-year follow up for each patient.

Results: 36 patients were identified with a median age of 52 (interquartile range [IQR] 46, 57) years. 78% were male, 53% were African American, 19% were Caucasian, and 17% were Hispanic. The most common cause of renal failure was hypertensive nephrosclerosis (51%) followed by HIV-associated nephropathy (17%), and the median duration of pre-transplant dialysis was 6.2 (3.2, 8.9) years.

All patients received IL-2 receptor antagonist (IL-2 RA): 81% with basiliximab and 19% with daclizumab induction. One patient also received thymoglobulin. Calcineurin inhibitor therapy included tacrolimus (75%), cyclosporine (19%), or transitions between these two (6%). 44% of patients received a rtv+ PI-based HAART regimen.

Overall one-year patient and graft survival was 94% and 92%, respectively, and the mean serum creatinine was 1.35 (1.21, 1.80). Treated biopsy-proven rejection within one year was 33% for the overall cohort; 44% for patients on rtv+ PI and 25% for patients on other HAART regimens (p=0.29).

Conclusion: Despite high rates of acute rejection, HIV+ kidney transplant recipients have excellent outcomes. Though not statistically significant (likely related to the small number of patients), higher rejection rates were observed in the rtv+ PI group. Future studies should evaluate whether thymoglobulin induction is associated with lower rejection rates compared to IL-2 RA induction.

CITATION INFORMATION: Rollins B, Lerner S, Rana M, Huprikar S, Miko L, Nair V, Florman S, Shapiro R. The Impact of Ritonavir-Boosted Protease Inhibitors and Non-Depleting Antibody Induction on Outcomes in HIV-Infected Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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