Combination Drug Products for HIV—A Word of Caution for the Transplant Clinician

Modern‐day treatment regimens for human immunodeficiency virus (HIV) are not only highly effective, but are now more often available as convenient fixed‐dose combination products. Furthermore, as medication adherence is of utmost importance in this setting, national guidelines endorse the use of suc...

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Bibliographic Details
Published in:American journal of transplantation 2016-08, Vol.16 (8), p.2479-2482
Main Authors: Patel, S. J., Kuten, S. A., Musick, W. L., Gaber, A. O., Monsour, H. P., Knight, R. J.
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
antibiotic: antiviral
Antibiotics
Antiviral drugs
Calcineurin
calcineurin inhibitor (CNI)
Calcineurin inhibitors
Calcineurin Inhibitors - adverse effects
Case reports
clinical research/practice
Drug Combinations
Drug interaction
Drug Interactions
Drug metabolism
Familiarity
Glomerular Filtration Rate
Graft Rejection - etiology
Health risk assessment
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - surgery
HIV-1 - drug effects
Human immunodeficiency virus
Humans
immunosuppressant
immunosuppression/immune modulation
Immunosuppressive agents
Immunosuppressive Agents - adverse effects
infection and infectious agents
infectious disease
Kidney Function Tests
Kidney Transplantation
Male
Metabolism
Patients
Pharmaceutical industry
pharmacokinetics/pharmacodynamics
Phenytoin
Prognosis
Risk Factors
Toxicity
viral: hepatitis C
viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
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Summary:Modern‐day treatment regimens for human immunodeficiency virus (HIV) are not only highly effective, but are now more often available as convenient fixed‐dose combination products. Furthermore, as medication adherence is of utmost importance in this setting, national guidelines endorse the use of such products. Transplant providers of HIV‐infected patients will undoubtedly encounter these products, some of which contain medications known to drastically alter the metabolism of certain immunosuppressants. Herein, we describe an instance of drug interaction–induced calcineurin inhibitor (CNI) nephrotoxicity in a renal transplant recipient being started on a cobicistat‐containing combination product for HIV. CNI toxicity, in turn, was resolved with the aid of phenytoin as an inducer of drug metabolism. This case underscores the importance of familiarity with newer combination products on the market and constant communication with HIV‐positive transplant recipients and their providers. The authors present a case of acute calcineurin inhibitor nephrotoxicity caused by a drug interaction in an HIV‐positive kidney transplant recipient that is subsequently managed by therapeutic use of an alternate drug interaction.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.13826