Integrase strand transferase inhibitors: the preferred antiretroviral regimen in HIV-positive renal transplantation
Integrase strand transferase inhibitors: the preferred antiretroviral regimen in HIV-positive renal transplantation
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DOI：
10.1177/0956462416651528
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发表时间：
2017-04-01
影响因子：
1.4
通讯作者：
Villanueva, Merceditas S.
中科院分区：
文献类型：
--
作者：
Azar, Marwan M.;Malinis, Maricar F.;Villanueva, Merceditas S.
在抗逆转录病毒治疗的时代，艾滋病毒/艾滋病感染者的寿命更长，并容易患上影响普通人群的并发症，如慢性肾病。越来越多的患有终末期肾病的艾滋病毒/艾滋病感染者成为肾移植的候选人。既往经验表明，HIV阳性肾移植受者的存活率可接受，但移植物存活率降低，排斥反应率增加，这可能是由于免疫抑制药物与抗逆转录病毒治疗（特别是蛋白酶抑制剂和非核苷类逆转录酶抑制剂）发生相互作用时，免疫抑制药物管理不佳所致。整合酶链转移酶抑制剂是有利的，因为它们避免了与免疫抑制药物如钙调磷酸酶抑制剂的药物-药物相互作用。我们报告了2000年至2015年期间在我们机构接受13次肾移植的12例HIV阳性患者的临床结局。累积生存率为75%，1年和3年生存率分别为100%和63%。在9例患者中使用了基于整合酶链转移酶的方案，其中8例存活。在使用整合酶链转移酶抑制剂的患者中，移植物存活率为100%，2例发生同种异体移植物排斥反应。相比之下，3例接受非整合酶链转移酶治疗方案的患者发生了移植失败。根据我们的研究结果和以前发表的数据，我们得出结论，整合酶链转移酶为基础的治疗，最好在移植前开始，是HIV阳性肾移植的首选抗逆转录病毒治疗方案。
In the era of antiretroviral therapy, people living with HIV/AIDS live longer and are subject to co-morbidities that affect the general population, such as chronic kidney disease. An increasing number of people living with HIV/AIDS with end-stage renal disease are candidates for renal transplantation. Prior experience demonstrated that HIV-positive renal transplant recipients had acceptable survival but graft survival was decreased and rejection rates were increased, possibly due to suboptimal management of immunosuppressive medications in the face of drug interactions with antiretroviral therapy, particularly protease inhibitors and non-nucleoside reverse transcriptase inhibitors. Integrase strand transferase inhibitors are advantageous since they avoid drug-drug interactions with immunosuppressive drugs such as calcineurin inhibitors. We report clinical outcomes of 12 HIV-positive patients who underwent 13 kidney transplantations at our institution between 2000 and 2015. Cumulative survival was 75%, one-year and three-year survival were 100% and 63%. Integrase strand transferase inhibitor-based regimens were used in nine patients, of which eight survived. In patients on integrase strand transferase inhibitor, there was 100% graft survival and two had allograft rejection. In contrast, graft failure occurred in three patients on non-integrase strand transferase inhibitor-based regimens. Based on our study findings and on previously published data, we conclude that integrase strand transferase inhibitor-based therapy, preferably instituted prior to transplantation, is the preferred antiretroviral regimen in HIV-positive renal transplantation.