Drug-drug interactions in patients living with HIV who undergo solid organ transplant

Through vigorous advocacy by medical community and political support, people with HIV (PWH) with end-stage organ disease can now receive kidney and liver transplants without the restriction of being performed within the confines of research. Evidence shows that PWH enjoy similar post transplant outcomes with organs from HIV-positive donors as those in the general population. However, a fine balance needs to be maintained between type (or class) and doses of antiretroviral therapy and antirejection medications to prevent or mitigate toxicity or loss of efficacy and to maintain good post-transplant outcomes. Metabolism pathways and DDIs between contemporary antiretrovirals and antirejection medications are reviewed. Data was drawn from an extensive literature review of published papers, conference abstracts, as well as unpublished data from approved drug prescribing information and regulatory submissions sourced from PubMed, Google, and Google Scholar available between 30 June 1980 through 31 December 2024. Management of drug-drug interactions is essential for maintaining efficacy and safety of ARV as well as antirejection medications in PWH who have received solid organ transplants. Due to their narrow therapeutic indices, therapeutic drug monitoring for antirejection medications are a useful tool to ensure that target drug levels are maintained.