Introduction:

HIV+ individuals can receive kidney transplant (KT) safely and effectively but face additional challenges from potential drug interactions between antiretroviral therapy (ART) and immunosuppression(IS). Little is known about the need for ART modification before KT in HIV+ KT candidates.

Methods

We performed a single-center chart review of all HIV+ patients who were evaluated for KT from June 2009 to August 2015. We described the ART of patients who are on the waiting list and instances of ART modifications.

Results

Forty-five HIV+ waitlisted patients were included in the chart review. The median age of the cohort was 50 years and 91% were African-American. Median CD4 count was 532 cells/mm³ and 95 % had controlled viremia (VL < 200 copies/ml). Less than a half (n=19, 42%) were on optimal ART recommended by guideline. Twenty-four patients (53%) needed ART adjustment to avoid protease inhibitor related drug-drug interactions, of which 9 (20%) were changed, 10 (22.2%) were in the process of changing, and 5 (11.1%) were unable to be changed due to past resistant profile.

Discussion

The majority of HIV+ patients waiting for KT at our center were on suboptimal ART likely because of limited options given the need for for renal dosage adjustment. More than half of waitlisted HIV+ patients required ART modifications to avoid future drug interactions between protease and calcineurin inhibitors. HIV providers should be aware of the potential impacts of ART drug regimens on their patients's KT candidacy.

CITATION INFORMATION: Lee D, Malat G, Bias T, Epstein S, Levin Mizrahi L, Harhay M, Talluri S, Ranganna K. Antiretroviral Therapy Modification of HIV+ Patients Listed for Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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