title: Combination Drug Products for HIV-A Word of Caution for the Transplant Clinician.
abstract: 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.
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, TX.
authors.forename: S J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, TX.
authors.forename: S A
authors.initials: SA
authors.lastname: Kuten
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, TX.
authors.forename: W L
authors.initials: WL
authors.lastname: Musick
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX.
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, TX.
authors.forename: H P
authors.initials: HP
authors.lastname: Monsour
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX.
authors.forename: R J
authors.initials: RJ
authors.lastname: Knight
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000009:adverse effects; D004338:Drug Combinations; D004347:Drug Interactions; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D011379:Prognosis; D012307:Risk Factors
chemical_list: D065095:Calcineurin Inhibitors; D004338:Drug Combinations; D007166:Immunosuppressive Agents
keywords: antibiotic: antiviral; calcineurin inhibitor (CNI); clinical research/practice; immunosuppressant; immunosuppression/immune modulation; infection and infectious agents; infectious disease; pharmacokinetics/pharmacodynamics; viral: hepatitis C; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)