Purpose: The purpose of this study was to determine the difference in 6 and 12 month graft function between patients with human immunodeficiency virus (HIV) on ritonavir containing antiretroviral regimens and those on ritonavir free regimens.

Methods: This single-institution retrospective study included adult patients who were infected with HIV and received a kidney transplant between 2007 and 2016. Patients were required to have at least 6 months of follow up and excluded if they had primary graft failure. Patients were divided into two groups: those taking ritonavir and those taking a ritonavir free regimen. The primary endpoint compared glomerular filtration rate (GFR) calculated via the MDRD equation at 6 and 12 months post-transplant. The secondary endpoints compared the rates of biopsy proven acute rejection (BPAR), treatment of rejection, incidence of delayed graft function, rates of graft failure, and rates of hospitalization within one year of transplantation.

Results: Forty-seven patients met inclusion criteria, including 30 who received ritonavir-containing regimens and 17 who received ritonavir-free regimens. Most patients were African American (87.2%) who received a kidney from a deceased donor (85.1%). There were no differences in baseline characteristics including age, race, cold ischemia time, type of donor, and CDC high risk donor criteria. There was no statistically significant difference in GFR at 6 and 12 months. Mean GFR at 6 months for the ritonavir group was 53 versus 48 mL/min/1.73m² in the ritonavir free group (p=0.368). At 12 months, mean GFR in the ritonavir group was 52 compared to 47 mL/min/1.73m² in the ritonavir free group (p=0.506). Similar rates of BPAR were observed: 50% in the ritonavir group versus 59% in the ritonavir free group (p=0.762). No significant difference in any of the secondary endpoints was identified. Of the 30 patients in the ritonavir group, 10 (33.3%) patients were taken off of ritonavir within 1 year of transplant.

Conclusion: There was no clinically significant impact of ritonavir-containing antiretroviral regimens on graft function, graft failure, BPAR, treatment of rejection, or hospitalizations seen in this study. We conclude that ritonavir containing antiretroviral regimens are safe to use in HIV infected patients after transplant, although a ritonavir containing regimen may lead to more difficulty managing immunosuppression regimens, as evidenced by the high rate of ritonavir discontinuation.

CITATION INFORMATION: Roach K, Meredith E, Lyon M. Impact of Ritonavir on Graft Function in Human Immunodeficiency Virus Infected Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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