Use of edoxaban for the treatment of venous thromboembolism in HIV-infected patients

Recent evidence suggests that HIV may be involved in a major incidence of venous thromboembolism (VTE) related both to HIV pro-inflammatory changes and to viral affection of haematological system. Direct oral anticoagulants (DOACs) have changed the treatment of VTE; however, co-administration with highly active antiretroviral therapy (HAART) should be considered with caution, because of potential drug–drug interactions. We report 3 cases of HIV-infected patients successfully treated with edoxaban while on HAART. A 63-year-old man while on HAART with emtricitabine/rilpivirine (as hydrochloride)/tenofovir disoproxil for 10 years with undetectable HIV RNA started edoxaban for recurrent VTE on October 2018. The second case is a 62-year-old man who had been on HAART with emtricitabine/tenofovir disoproxil and raltegravir for 10 years. In November 2018, edoxaban was started for acute DVT. The third case is  a 60-year-old man who was diagnosed with HIV infection, pulmonary embolism and DVT in November 2018. He started HAART with emtricitabine/tenofovir disoproxil and dolutegravir and edoxaban. Edoxaban plasma levels were in the expected therapeutic range (10–39 ng/mL): 33 ng/mL for patient 1, 24 ng/mL for patient 2 and 10 ng/mL for patient 3. The patients did not report any haemorrhagic or thrombotic adverse events during the clinical follow-up and HIV RNA remained undetectable. Edoxaban is minimally metabolized by Cytochrome P450 3A4 (< 10%) and is transported via P-glycoprotein (P-gp). Our patients were on HAART with drugs that are metabolized predominantly by cytochrome P450 and that do not affect the P-gp pathways, co-administration was safe at the full dose.