Significant interaction of tacrolimus with ritonavir during allogeneic hematopoietic SCT in an HIV-infected patient

M Miceli, S Cronin, L Ayash, G Alangaden… - Bone marrow …, 2012 - nature.com
M Miceli, S Cronin, L Ayash, G Alangaden, PH Chandrasekar
Bone marrow transplantation, 2012nature.com
Widespread use of highly active antiretroviral therapy (HAART) has revolutionized the
management of patients with human immunodeficiency virus (HIV) infection. Incidence of
opportunistic infections has significantly decreased and now malignancies, including non-
AIDS defining malignancies, are the leading cause of mortality in this population. 1--3
Allogeneic hematopoietic SCT (HSCT) is a well-established therapeutic option for the
treatment of malignant and nonmalignant hematopoietic disorders. 4 Although …
Widespread use of highly active antiretroviral therapy (HAART) has revolutionized the management of patients with human immunodeficiency virus (HIV) infection. Incidence of opportunistic infections has significantly decreased and now malignancies, including non-AIDS defining malignancies, are the leading cause of mortality in this population. 1--3 Allogeneic hematopoietic SCT (HSCT) is a well-established therapeutic option for the treatment of malignant and nonmalignant hematopoietic disorders. 4 Although transplantation was not considered a feasible option for HIV-infected patients in the pre-HAART era, currently there is evidence of safety and efficacy of autologous HSCT as well as solid organ transplantation in this population. 5--7 However, available data are scant for allogeneic HSCT in the setting of HIV infection. 8 HIV-infected patients undergoing allogeneic HSCT are likely to experience many drug--drug interactions in view of the concurrent use of multiple drugs. In this report, we describe a case of a serious interaction between tacrolimus and the HIV protease inhibitor ritonavir in an HIV-infected patient who underwent an allogeneic HSCT for refractory non-Hodgkin’s lymphoma. A 47-year-old Caucasian man had a chronic history of HIV infection and Hepatitis B virus (HBV) coinfection. At diagnosis, his CD4+ lymphocyte count was 60cells/mm3. HAART regimen included darunavir, ritonavir, tenofovir and emtricitabine. Infection prophylaxis included daily trimethoprim--sulfamethoxazole and once weekly azithromycin for prevention of infections due to
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