Clinically significant drug interactions between antiretroviral and co-prescribed drugs in HIV infected patients: retrospective cohort study

Abstract

Introduction. There are limited data on human immunodeficiency viruses (HIV) infected people in the UAE and the Gulf region. This study aimed at assessing the prevalence and risk factors for potential clinically significant drug interactions (CSDIs) in a cohort of 181 HIV infected people in Dubai.
 Methods. A retrospective study was conducted at the outpatient infectious diseases clinic of Rashid hospital. Consecutive HIV seropositive people on anti-retroviral therapy (ART) were included. All potential CSDIs were analyzed and classified using Liverpool HIV drug interactions database.
 Results. Nucleoside reverse transcriptase inhibitors (NRTIs) and integrase strand transfer inhibitors (INSTIs) were the most frequently used antiretroviral agents (ARVs), while the most common (non-ARV) were cardiovascular medication followed by antilipidemic statins. A total of 140 potential CSDIs were found in nearly half (n=86, 47.5%) of the 181 included HIV persons. Of the 140 potential CSDIs, 27 (19%) were of weak clinical relevance, 108 (77%) were of potential clinical relevance, and 5 (4%) were of contraindicated clinical relevance interactions. Moreover, 52 (37.14%) of CSDIs were between two ARVs and 88 (62.85%) were between ARV and non-ARV drugs. In the univariate analysis, age, dyslipidemia, number of medications, analgesics use, statin use, supplement intake, time since diagnosis of HIV, number of ART, and use of a protease inhibitor (PI) were significant. In the logistic regression, factors independently associated with CSDIs were the number of medications (odds ratio [OR] 1.165, 95% CI 1.021-1.329, P = 0.023) and the time since diagnosis of HIV (OR 1.156, 95% CI 1.008-1.327, P = 0.038).
 Conclusion. The frequency of CSDIs between ART and co-medications is high in HIV seropositive people. Awareness of the risk factors may assist clinicians to recognize and manage CSDIs.

Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy—Update 2022: Systematic Review

“…Currently, some systematic reviews, meta-analyses, and randomized clinical trials provide sufficient evidence that some drug interactions may cause negative health outcomes in PLHIV. Overall, clinically relevant drug interactions occur in 20-30% of PLHIVs [207], including recently authorized ARV drugs, mainly explained through pharmacokinetics changes linked to the inhibition or induction of different enzymes and metabolic transporters [3,[5][6][7][8]208].…”