The best single time point measurement correlations with AUC for cyclosporine and tacrolimus in HIV-1 infected liver and kidney transplant recipients (poster session)
Year of Publication
Frassetto, L; Tan-Tam, C; Barin, B; Browne, M; Wolfe, A; Stock, P; Roland, M; Benet, L
World Congress of Nephrology
INTRODUCTION AND AIMS: Inadequate dosing of immunosuppressants (IS) is a risk factor for graft rejection among HIV-infected transplant recipients. In non-HIV transplant patients, trough level (C0) and concentration 2 hours after dosing (C2) are used to monitor levels of the IS drugs CsA and TAC. However, because of drug interactions in HIV-infected transplant patients, IS levels can change. The goal of this study is to determine the best method for monitoring IS levels in patients who are concomitantly taking protease inhibitors (PIs), non-nucleoside reverse-transcriptase inhibitors (NNRTIs), or both. METHODS: We conducted a prospective study of 50 HIV-infected transplant recipients. The pharmacokinetics of the PIs and the two common NNRTIs were studied before transplantation and, in combination with CsA or TAC, after transplantation (weeks 2 to 4, 12, 28, 52, and 104). Here we report on changes to the IS kinetics. RESULTS: In patients concomitantly taking PIs, NNRTIs or both, the CsA concentration at C4 generally correlated better with the AUC than did C0 or C2; while this was true at week 2 for TAC, C0 or C2 correlated better for the later studies for both PIs and NNRTIs. Our results suggest though measurements may be adequate for TAC monitoring, but C2 or C4 should be preferred for predicting AUC with CsA, especially subjects at high risk for rejection.