title: Impact of antiretroviral therapy on clinical outcomes in HIV+kidney transplant recipients: Review of 58 cases.
abstract: Background:Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients.  We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV+kidney transplant recipients.Methods:A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV-to HIV+adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation.  The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant.Results:Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% (p=0.06) and 82% vs. 100% (p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602;p=0.02).  Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%,p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%,p=0.01).Conclusions:PI-containing ART regimens are associated with adverse outcomes in HIV+kidney transplant recipients.
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, USA.|UnityPoint Health, Des Moines, USA.
authors.forename: Rossana
authors.initials: R
authors.lastname: Rosa
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Suarez
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Lorio
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, USA.|Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Abbo
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Jacques
authors.initials: J
authors.lastname: Simkins
authors.affiliation: Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Giselle
authors.initials: G
authors.lastname: Guerra
authors.affiliation: Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.affiliation: Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Warren L
authors.initials: WL
authors.lastname: Kupin
authors.affiliation: Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Adela
authors.initials: A
authors.lastname: Mattiazzi
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, USA.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, USA.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Figueiro
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Jose F
authors.identifier: 0000-0001-9584-5011
authors.initials: JF
authors.lastname: Camargo
keywords: HIV; antiretroviral therapy; infection; kidney transplant; protease inhibitor