Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease

Moltó, José; Graterol, Fredzzia; Miranda, Cristina; Khoo, Saye; Bancu, Ioana; Amara, Alieu; Bonjoch, Anna; Clotet, Bonaventura

doi:10.1128/aac.03131-15

Cited by 16 publications

(26 citation statements)

References 13 publications

(13 reference statements)

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“…Raltegravir and dolutegravir are primarily metabolized via the hepatic pathway and minimally excreted in the urine. Thus, these InSTIs are not dose‐reduced in ESRD, and based on small studies, are not cleared by dialysis . Elvitegravir is currently only available in fixed‐dose combinations with cobicistat, emtricitabine, and TDF or TAF, and cannot be used in ESRD patients because the tenofovir prodrugs and emtricitabine (NRTIs) require dose reduction …”

Section: Antiretroviral Therapymentioning

confidence: 99%

HIV in the dialysis population: Current issues and future directions

Boyle

Lee

Wyatt

2017

Seminars in Dialysis

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Antiretroviral therapy has significantly reduced mortality due to HIV infection, but the aging HIV-positive patient population now faces a growing burden of comorbidity. This review describes the changing epidemiology of chronic kidney disease and end-stage renal disease in this population, and highlights recent advances in antiretroviral therapy and kidney transplantation that directly impact the care of patients with HIV infection and end-stage renal disease.

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Section: Antiretroviral Therapymentioning

confidence: 99%

HIV in the dialysis population: Current issues and future directions

Boyle

Lee

Wyatt

2017

Seminars in Dialysis

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“…Dialysate (20 ml) was directly collected from the dialysate port of the dialyzer. Ambrisentan concentrations in both plasma and dialysate were determined using high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) using a validated method [10], and the hemodialysis extraction ratio (ER) for ambrisentan was calculated following standard procedures [5]. The patient gave and signed an informed consent before sampling took place.…”

Section: Case Presentationmentioning

confidence: 99%

“…4 Nephrology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. 5 Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany. 6 Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…Drug removal by hemodialysis is an essential factor in determining different dosing regimens. However, the pharmacokinetics of many drugs in patients on hemodialysis has been poorly studied, and information about their hemodialyzability remains scant [3][4][5]. In addition, HIV patients with PAH or ESRD are frequently affected by other co-morbidities that require specific therapies.…”

Section: Introductionmentioning

confidence: 99%

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Ambrisentan use in a HIV-1 infected patient with end-stage renal disease and pulmonary hypertension: minimal removal by hemodialysis - a case report

et al. 2020

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Background: Ambrisentan is a selective endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension (PAH). Little is known about ambrisentan removal by hemodialysis in patients with end-stage renal disease (ESRD). Case presentation: A 53-year-old woman with HIV/hepatitis C virus (HCV) co-infection, PAH and ESRD on regular hemodialyis was admitted in our hospital due to refractory heart failure while on treatment with bosentan (125 mg twice daily) and tadalafil (20 mg once daily) for PAH and antiretroviral treatment (cART) including darunavir/ cobicistat (800/150 mg once daily). Excessive exposure to bosentan due to drug interactions between bosentan and darunavir/cobicistat was suspected. Bosentan was replaced by ambrisentan, with progressive improvement in her clinical condition. Pre-and postdialyzer cocentrations of ambrisentan in plasma were determined and hemodialysis extraction ratio for ambrisentan was 2%. Conclusions: Our results suggest that hemodialysis results in minimal ambrisentan removal, and therefore no specific ambrisentan dosage adjustment seems to be required in ESRD patients undergoing hemodialysis.

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“…There are reports concerning conventional drugs and the impact of dialysis on the pharmacokinetics of the antiretroviral drugs used to treat HIV [5]. Although the antiviral activity of DTG is known to be retained upon its elimination by hemodialysis [6], no reports exist on the pharmacokinetics of RPV in ESRD patients.…”

Section: Introductionmentioning

confidence: 99%

Changes in serum concentration of rilpivirine in an HIV-infected patient treated with a combination therapy of hemodialysis and peritoneal dialysis

et al. 2020

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Background: To our knowledge, there are no preexisting reports concerning rilpivirine (RPV) removal by hemodialysis and peritoneal dialysis. Case presentation: This study aimed to evaluate the effect of hemodialysis and peritoneal dialysis on plasma concentrations of RPV in a 45-year-old man infected with HIV and exhibiting end-stage renal disease (ESRD). The extraction ratio of RPV by hemodialysis was 4.5%. Plasma concentrations of RPV remained far above the proteinbinding-adjusted inhibitory levels during a combination therapy of hemodialysis and peritoneal dialysis. Our results suggest minimal RPV removal via hemodialysis and peritoneal dialysis with no specific dosage adjustments required in an HIV-infected patient undergoing this combination therapy. Conclusion: In conclusion, this study showed that RPV administered without dose adjustment resulted in steadystate plasma drug concentration in an HIV-infected patient treated with a combination therapy of hemodialysis and peritoneal dialysis.

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Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease

Cited by 16 publications

References 13 publications

HIV in the dialysis population: Current issues and future directions

HIV in the dialysis population: Current issues and future directions

Ambrisentan use in a HIV-1 infected patient with end-stage renal disease and pulmonary hypertension: minimal removal by hemodialysis - a case report

Changes in serum concentration of rilpivirine in an HIV-infected patient treated with a combination therapy of hemodialysis and peritoneal dialysis

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