Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review

Abstract

The pharmacotherapeutic management of people living with HIV (PLWHIV) undergoing solid organ transplantation (SOT) is clinically challenging, mainly due to the frequent occurrence of complex drug-drug interactions. Although various strategies have been proposed to improve treatment outcomes in these patients, several uncertainties remain, and consensus practice guidelines are just beginning to emerge. The main objective of this scoping review was to map the extent of the literature on the pharmacotherapeutic interventions performed by healthcare professionals for PLWHIV undergoing SOT.

Methods: We searched Medline, Embase, and the Cochrane databases as well as gray literature for articles published between January 2010 and February 2020. Study selection was performed by at least 2 independent reviewers. Articles describing pharmacotherapeutic interventions in PLWHIV considered for or undergoing SOT were included in the study.

Results: Of the 12 599 references identified through our search strategy, 209 articles met the inclusion criteria. Results showed that the vast majority of reported pharmacotherapeutic interventions concerned the management of immunosuppressive and antimicrobial therapy, including antiretrovirals. Analysis of the data demonstrated that for several aspects of the pharmacotherapeutic management of PLWHIV undergoing SOT, there were differing practices, such as the choice of immunosuppressive induction and maintenance therapy. Other important aspects of patient management, such as patient counseling, were rarely reported.

Conclusions: Our results constitute an extensive overview of current practices in the pharmacotherapeutic management of SOT in PLWHIV and identify knowledge gaps that should be addressed to help improve patient care in this specific population.

FIGURE 1.

Pharmacotherapeutic interventions of solid organ transplantation in PLWHIV. The central element of this framework in blue is the exposure defined as the solid organ transplantation, green boxes illustrate pharmacotherapeutic intervention themes distributed on a time axis and red boxes represent graft-related clinical outcomes. PLWHIV, people living with HIV.

FIGURE 2.

PRISMA diagram of article selection process. Selected articles were those describing pharmacotherapeutic interventions related to the management of antiretrovirals and immunosuppressive therapy, prevention and management of complications of solid organ transplantation, prevention and treatment of infections, management of drug–drug interactions, therapeutic drug monitoring and drug-related patient counseling. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PT, pharmacotherapeutic.

FIGURE 3.

Number of pharmacotherapeutic interventions by categories. A, Number of pharmacotherapeutic interventions after classification in subgroups. B, Number of pharmacotherapeutic interventions by categories pre- and postsolid organ transplantation (only interventions for which this information was available are represented). ART, antiretroviral therapy; SOT, solid organ transplantation; tx, transplantation.

FIGURE 4.

Percentage of pharmacotherapeutic interventions by subgroups. Heat maps represent the frequency of pharmacotherapeutic interventions as the percentage of the total number of interventions collected in each of the following categories: induction and maintenance of immunosuppression therapy (A and B), prevention and management of infections (C), ARV therapy (D), therapeutic drug monitoring/management of DDI (E), post-transplant follow-up (F), and management of noninfectious complications (G). Interventions that represented a minimum of 2% of all interventions in each subgroup are shown in the graph. Anti-IL-2R, anti-interleukin-2 receptor; ARV, antiretroviral; CI, calcineurin inhibitor; CMV, cytomegalovirus; DDI, drug–drug interactions; HBV, hepatitis B virus; HCV, hepatitis C virus; InSTI, integrase strand transfer inhibitor; IS, immunosuppressive; IV, intravenous; mTOR, mammalian target of rapamycin; NNRTI, nonnucleoside reverse transcriptase inhibitor; OI, opportunistic infection; PI, protease inhibitor; PJP, Pneumocystis jirovecii pneumonia; SOT, solid organ transplantation; TDF, tenofovir disoproxil fumarate; TDM, therapeutic drug monitoring; TMP-SMX, trimethoprim-sulfamethoxazole.

FIGURE 5.

Pharmacotherapeutic interventions describing the use of immunosuppressive agents for induction therapy in kidney and liver transplant. The total number of pharmacotherapeutic interventions reporting the use of immunosuppressive agents for induction therapy are presented for each agent. Anti-IL-2R, anti-interleukin-2 receptor antibodies; IV, intravenous.