Switch from a ritonavir to a cobicistat containing antiretroviral regimen and impact on tacrolimus levels in a kidney transplant recipient.

Erba, Andrea, Marzolini, Catia ORCID: 0000-0002-2312-7050, Rentsch, Katharina, Stoeckle, Marcel, Battegay, Manuel, Mayr, Michael ORCID: 0000-0002-1962-8186 and Weisser, Maja ORCID: 0000-0002-0134-1929 (2023) Switch from a ritonavir to a cobicistat containing antiretroviral regimen and impact on tacrolimus levels in a kidney transplant recipient. Virology journal, 20 (1). 89-.

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Official URL: http://dx.doi.org/10.1186/s12985-023-02058-3

Abstract

<h4>Background</h4>Solid-organ transplantation due to end-stage organ disease is increasingly performed in people living with HIV. Despite improved transplant outcomes, management of these patients remains challenging due to higher risk for allograft rejection, infection and drug-drug interactions (DDIs). Complex regimens for multi-drug resistant HIV-viruses may cause DDIs particularly if the regimen contains drugs such as ritonavir or cobicistat.<h4>Case presentation</h4>Here we report on a case of an HIV-infected renal transplant recipient on long-term immunosuppressive therapy with mycophenolate mofetil and tacrolimus dosed at 0.5 mg every 11 days due to the co-administration of a darunavir/ritonavir containing antiretroviral regimen. In the presented case the pharmacokinetic booster was switched from ritonavir to cobicistat for treatment simplification. A close monitoring of tacrolimus drug levels was performed in order to prevent possible sub- or supratherapeutic tacrolimus trough levels. A progressive decrease in tacrolimus concentrations was observed after switch requiring shortening of tacrolimus dosing interval. This observation was unexpected considering that cobicistat is devoid of inducing properties.<h4>Conclusions</h4>This case highlights the fact that the pharmacokinetic boosters ritonavir and cobicistat are not fully interchangeable. Therapeutic drug monitoring of tacrolimus is warranted to maintain levels within the therapeutic range.

Item Type:	Article
Uncontrolled Keywords:	Humans, HIV Infections, Tacrolimus, Ritonavir, Anti-Retroviral Agents, Anti-HIV Agents, Kidney Transplantation, Cobicistat
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	29 Feb 2024 09:20
Last Modified:	29 Feb 2024 09:20
DOI:	10.1186/s12985-023-02058-3
Open Access URL:	https://doi.org/10.1186/s12985-023-02058-3
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179000