Background and Objectives

Liver transplantation is now considered a safe procedure in patients with HIV because of the advent of potent antiretroviral therapies (ART).

Objective

We aimed to describe the use of dolutegravir-based maintenance ART in patients with HIV and liver transplant regularly followed in our hospital.

Methods

We searched the database of our Department of Infectious Diseases for liver transplant recipients receiving calcineurin inhibitor-based maintenance immunosuppression concomitantly treated with dolutegravir for at least 1 month.

Results

Ten HIV-positive liver transplant recipients were identified. At 4.6 ± 3.5 years post-transplant, all the patients were switched to dolutegravir-based therapies for treatment simplification. However, at 1 year after the switch, five of the ten patients returned to their previous ART regimens because of increased serum transaminases (n = 1), reversible increased serum creatinine (n = 4), repeated episodes of nausea/vomiting (n = 1) and variable out-of-range concentrations of tacrolimus or cyclosporine (n = 2). However, it should be recognized that these events cannot be unequivocally ascribed to dolutegravir and, in the case of increased serum creatinine, are predictable.

Conclusions

The management of HIV-positive liver transplant recipients in clinical practice is a complex task, where possibility of simplifying antiretroviral regimens must be balanced with the need to guarantee optimal immunosuppression and the finest treatment tolerability. A multidisciplinary approach involving physicians and clinical pharmacologists/pharmacists could help achieve this goal.

中文翻译：

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基于Dolutegravir的抗逆转录病毒疗法在现实生活中可用于HIV肝移植患者。

背景和目标

由于有效的抗逆转录病毒疗法（ART）的出现，肝移植现已被认为是HIV患者的安全手术。

目的

我们旨在描述在我院定期随访的艾滋病毒和肝移植患者中使用基于dolutegravir的维持性ART的情况。

方法

我们在传染病数据库中搜索了接受钙调磷酸酶抑制剂为基础的维持性免疫抑制治疗并同时接受dolutegravir治疗至少1个月的肝移植受者。

结果

确定了十名艾滋病毒阳性肝移植受者。移植后4.6±3.5年，所有患者均转用基于dolutegravir的疗法以简化治疗。但是，在转换后1年，十名患者中有五名因血清转氨酶升高（n  = 1），血清肌酐可逆性升高（n  = 4），反复出现恶心/呕吐（n  = 1）他克莫司或环孢霉素的浓度超出范围（n  = 2）。但是，应该认识到，这些事件不能明确地归因于dolutegravir，并且在血清肌酐升高的情况下是可以预见的。

结论

在临床实践中，HIV阳性肝移植受者的管理是一项复杂的任务，在简化抗逆转录病毒治疗方案的可能性与保证最佳免疫抑制和最佳治疗耐受性的需求之间必须进行权衡。涉及医师和临床药理学家/药剂师的多学科方法可以帮助实现这一目标。