Sirolimus (SIR) is a potent immunosuppressive agent with multiple proprieties. We report beneficial antiviral effects of SIR in an HIV-positive kidney transplant recipient who experienced low-level HIV-1 replication. The immunosuppressive agent was well tolerated by the patient, and no side effects were reported during follow-up. Despite immunosuppressive monotherapy, SIR ensured stable graft function.
MorathCArnsWSchwengerV, et al.
Sirolimus in renal transplantation. Nephrol Dial Transplant2007;
22: viii61–viii65.
2.
ThomsonAWTurnquistHRRaimondiG.Immunoregulatory functions of mTOR inhibition. Nat Rev Immunol2009;
9: 324–337.
3.
DoniaMMcCubreyJABendtzenK, et al.
Potential use of rapamycin in HIV infection. Br J Clin Pharmacol2010;
70: 784–793.
4.
GilliamBLHerediaADevicoA, et al.
Rapamycin reduces CCR5 mRNA levels in macaques: potential applications in HIV-1 prevention and treatment. AIDS Lond Engl2007;
21: 2108–2110.
5.
NicolettiFLamentaCDonatiS, et al.
Inhibition of human immunodeficiency virus (HIV-1) infection in human peripheral blood leucocytes-SCID reconstituted mice by rapamycin. Clin Exp Immunol2009;
155: 28–34.
6.
KandilHStebbingJGazzardB, et al.
Innate and adaptive immunological insights into HIV pathogenesis. Int J STD AIDS2003;
14: 652–655.
7.
OzakiKSCâmaraNOSNogueiraE, et al.
The use of sirolimus in ganciclovir-resistant cytomegalovirus infections in renal transplant recipients. Clin Transplant2007;
21: 675–680.
8.
LiaciniASeamoneMEMuruveDA, et al.
Anti-BK virus mechanisms of sirolimus and leflunomide alone and in combination: toward a new therapy for BK virus infection. Transplantation2010;
90: 1450–1457.
9.
NicholsLAAdangLAKedesDH.Rapamycin blocks production of KSHV/HHV8: insights into the anti-tumor activity of an immunosuppressant drug. PLoS One2011;
6: e14535.
10.
HerediaAAmorosoADavisC, et al.
Rapamycin causes down-regulation of CCR5 and accumulation of anti-HIV beta-chemokines: an approach to suppress R5 strains of HIV-1. Proc Natl Acad Sci USA2003;
100: 10411–10416.
11.
KumarMSASierkaDRDamaskAM, et al.
Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients. Kidney Int2005;
67: 1622–1629.
12.
StockPGBarinBHatanoH, et al.
Reduction of HIV persistence following transplantation in HIV-infected kidney transplant recipients. Am J Transplant2014;
14: 1136–1141.
13.
Di BenedettoFDi SandroSDe RuvoN, et al.
First report on a series of HIV patients undergoing rapamycin monotherapy after liver transplantation. Transplantation2010;
89: 733–738.
14.
KnollGAKokoloMBMallickR, et al.
Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data. BMJ2014;
349: g6679.
15.
SantosAHCaseyMJXuerongW, et al.
Association of baseline viral serology and sirolimus regimens with kidney transplant outcomes: a 14-year registry-based cohort study in the United States. Transplantation2017;
101: 377–386.
16.
IzzedineHLaunay-VacherVBaumelouA, et al.
Antiretroviral and immunosuppressive drug-drug interactions: an update. Kidney Int2004;
66: 532–541.
17.
StockPGBarinBMurphyB, et al.
Outcomes of kidney transplantation in HIV-infected recipients. N Engl J Med2010;
363: 2004–2014.
18.
GathogoENHamzahLHiltonR, et al.
Kidney transplantation in HIV-positive adults: the UK experience. Int J STD AIDS2014;
25: 57–66.
19.
AlfanoGMoriGFontanaF, et al.
Clinical outcome of kidney transplantation in HIV-infected recipients: a retrospective study. Int J STD AIDS2018;
29: 1305–1315.
20.
IzzoICasariSBossiniN, et al.
Effectiveness of kidney transplantation in HIV-infected recipients under combination antiretroviral therapy: a single-cohort experience (Brescia, Northern Italy). Infection2018;
46: 77–82.
21.
HoerningAKöhlerSJunC, et al.
Cyclosporin but not everolimus inhibits chemokine receptor expression on CD4+ T cell subsets circulating in the peripheral blood of renal transplant recipients. Clin Exp Immunol2012;
168: 251–259.