Outcomes of kidney transplantation in HIV-infected recipients.

摘要

to the editor: Stock et al. report on, a disturbingly higher rejection rate among HIV-infected kidney-transplant recipients than among the general population of patients who have undergone kidney transplantation in the United States. They suggest this outcome is partly caused by the profound pharmacokinetic interaction between im-munosuppressants and protease inhibitors. Dosing of tacrolimus in transplant recipients is ideally based on a 12-hour area under the curve (AUC). In clinical practice, trough levels are usually monitored, assuming a correlation with AUCs. However, the pharmacokinetic curve of tacrolimus in HIV patients receiving protease inhibitors does not show the normal peak-and-trough pattern but rather resembles a flat line with a half-life of up to 20 days as a result of extremely strong inhibition of CYP3A. Therefore, and based on our findings, trough levels of tacrolimus in patients receiving protease inhibitors should be higher (17.5 ng per milliliter at 1 month and 10 ng per milliliter at 1 year after transplantation) than the trough levels reported by Stock et al. (9.1 ng per milliliter and 7.2 ng per milliliter, respectively) to achieve AUCs that are equal to those in patients who are not receiving protease inhibitors.