Bictegravir/emtricitabine/tenofovir alafenamide combination in the management of kidney transplant patients with HIV receiving immunosuppressants

J Chemother. 2022 May;34(3):199-202. doi: 10.1080/1120009X.2021.1940436. Epub 2021 Jun 26.

Abstract

We report here a drug-drug interaction with tacrolimus in a HIV-positive patient with renal transplant, after switch from highly active antiretroviral therapy with boosted protease inhibitors to the combination bictegravir/emtricitabine/tenofovir alafenamide. Although the tacrolimus doses were adapted to take account of the pharmacokinetic interactions with protease inhibitors, a tacrolimus overdosage occurred in the patient nonetheless. Through this case report, we highlight the need to consider a sufficient timeframe of withdrawal of protease inhibitors, which induce a prolonged drug-drug interaction with tacrolimus. To conclude, we purport that the combination bictegravir/emtricitabine/tenofovir alafenamide could be an attractive alternative in the context of transplantation provided a discontinuation of boosted protease inhibitors for more than 48 hours before introducing tacrolimus.

Keywords: Antiretroviral agents; interaction; kidney transplantation; pharmacology; tacrolimus; toxicity.

Publication types

  • Case Reports

MeSH terms

  • Adenine
  • Alanine
  • Amides
  • Anti-HIV Agents* / therapeutic use
  • Drug Combinations
  • Emtricitabine / therapeutic use
  • HIV Infections* / drug therapy
  • Heterocyclic Compounds, 3-Ring
  • Heterocyclic Compounds, 4 or More Rings / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation*
  • Piperazines
  • Protease Inhibitors / therapeutic use
  • Pyridones
  • Tacrolimus / therapeutic use
  • Tenofovir / analogs & derivatives

Substances

  • Amides
  • Anti-HIV Agents
  • Drug Combinations
  • Heterocyclic Compounds, 3-Ring
  • Heterocyclic Compounds, 4 or More Rings
  • Immunosuppressive Agents
  • Piperazines
  • Protease Inhibitors
  • Pyridones
  • bictegravir
  • Tenofovir
  • tenofovir alafenamide
  • Emtricitabine
  • Adenine
  • Alanine
  • Tacrolimus