Outcomes and management of viral hepatitis and human immunodeficiency virus co-infection in liver transplantation

Table 4 Drug-drug interactions: Antiretrovirals and immunosuppressants[54,102]

	Steroids	Calcineurin inhibitors (cyclosporine/tacrolimus)	mTOR inhibitors (sirolimus, everolimus)	Antimetabolites (mycofenylate mofitl)
PI	Significant increase	Significant increase in immunosuppression levels in general. Calcineurin inhibitor levels may increase or decrease with exposure to either amprenavir or fosamprenavir	Significant increase in immunosuppression levels	Generally no effect; levels may decrease with nelfinavir, lopinavir/ritonavir
NNRTI	Mild decrease in level	Mild decrease in level	Mild decrease in level	No effect on immunosuppressant levels. May decrease nevirapine levels
NRTI	No effect	No effect	No effect	May be increased with zidovudine
Integrase inhibitors	No effect	Increased with elvitegravir	Increased with elvitegravir	Increased with elvitegravir
CCR5-agonists	No effect
Fusion inhibitors	No effect

PI: Protease inhibitor; mTOR: Mammalian target of rapamycin; NNRTI: Non-nucleoside reverse transcriptase inhibitors; NRTI: Nucleoside reverse transcriptase inhibitors; CCR5: Chemokine receptor type.