Evolution of Drug Interactions With Antiretroviral Medication in People With HIV

Moussaoui, Majdouline El; Lambert, Iseult; Maes, Nathalie; Sauvage, Anne-Sophie; Frippiat, Frédéric; Meuris, Christelle; Uurlings, Françoise; Lecomte, Marianne; Léonard, Philippe; Fombellida, Karine; Vaira, Dolorès; Vercheval, Christelle; Moutschen, Michel; Darcis, Gilles

doi:10.1093/ofid/ofaa416

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…Although hydroxychloroquine was the most widely used drug, the greatest number of interactions were associated with lopinavir/ritonavir. Such a high prevalence, 26–47%, is consistent with studies in the HIV population 25 , 26 . This fact could be explained since ritonavir irreversibly inhibits CYP3A4 and lopinavir/ritonavir induces CYP1A2, CYP2C9, CYP2C19 and glucuronidation.…”

Section: Discussionsupporting

confidence: 90%

Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

Cantudo-Cuenca

Gutiérrez‐Pizarraya

Pinilla-Fernández

et al. 2021

Sci Rep

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Primary aim was to assess prevalence and severity of potential and real drug–drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) (‘potential interactions’) and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02–1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12–1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.

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Section: Discussionsupporting

confidence: 90%

Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

Cantudo-Cuenca

Gutiérrez‐Pizarraya

Pinilla-Fernández

et al. 2021

Sci Rep

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“…This was particularly true for people ageing with HIV, most likely because ART medications have an exceptionally large number of drug-drug interactions. 16,26 Second, after adjustment for demographics and physiological frailty, the KPDI Index based on non-ART medications explained an important portion, but by no means all, of the remaining association between polypharmacy and risk of hospitalisation. After full adjustment, the remaining associations were stronger for people ageing with HIV than those without HIV.…”

Section: Discussionmentioning

confidence: 99%

“…11 ART medications interact with a wide range of common medications including lipid-lowering agents, antihypertensives, antidepressants, proton-pump inhibitors, and opioid agonists. 15,16 However, no ready means of counting known drug-drug interactions, accounting for their differential effects, or comparing these by HIV status, has previously been available.…”

Section: Discussionmentioning

confidence: 99%

“…15 For example, boosted regimens, including protease inhibitors and the early integrase strand transfer inhibitor elvitegravir-cobicistat, can increase drug concentrations and risk of adverse effects of comedications via inhibition of CYP3A4 and transporters. 16 Interactions between ART and non-ART medications are associated with hospitalisation after adjusting for CD4 cell count, protease inhibitor-based regimen, substance use, and non-ART medication count. 17 While now being prescribed less frequently, use of boosted regimens remains common.…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study

Justice

Gordon

Romero

et al. 2021

The Lancet Healthy Longevity

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Background Polypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty.Methods In this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index. Findings We collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97•4%) of 47 116 patients were men and the sample was predominantly aged 50-64 years (30 413 [64•6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with fiveto-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1•09 in the random sample, 5•49 in the HIV-negative population, and 7•13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2•94 additional KPDIs and comparators had approximately 2•67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1•08 [95% CI 1•07-1•09] reduced to 1•06 [1•05-1•07]) and those without HIV (1•08 [1•07-1•08] reduced to 1•04 [1•03-1•05]).Interpretation For each additional medication, people ageing with HIV have more drug-drug interactions than those without HIV. Adjusting for known non-ART drug-drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes.

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“…Concernant la fréquence de la prescription des hypolipémiants, nos résultats concordent avec ceux des études antérieures [ 22 , 30 ]. La plupart des études réalisées en pays développé ont rapporté une grande fréquence de la prescription des médicaments cardiovasculaires [ 8 , 9 , 26 ].…”

Section: Discussionunclassified

Coût et facteurs associés à la prescription des médicaments non antirétroviraux chez les patients infectés par le VIH sous thérapie antirétrovirale dans un hôpital de référence au Maroc

Titou

Boui

Hjira

2022

Mtsi

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Résumé Objectif Déterminer les coûts des médicaments non antirétroviraux et identifier les facteurs associés à leur prescription chez les patients VIH-1 sous thérapie antiretrovirale au Maroc. Méthodes Étude rétrospective d’une cohorte de 264 malades vivant avec le VIH-1 mis sous thérapie antirétrovirale dans le service de dermatologie-vénérologie à l’hôpital militaire d’instruction Mohammed V de Rabat au cours de la période du 1er janvier 2014 au 31 décembre 2018. Les coûts retenus étaient ceux de la pharmacie de l’hôpital pour les médicaments essentiels, sinon le prix de vente en officine. Le modèle de régression logistique a été utilisé pour analyser les facteurs associés à la prescription. Résultats Sur les 264 patients inclus, la prédominance masculine était de 75 %. L’âge médian des patients était de 49 ans [41-57]. À l’inclusion, 21,2 % des patients étaient déjà au stade sida. Après une durée moyenne de suivi de traitement antirétroviral estimée à 11,1 ± 6,8 mois, 71,6 % des patients avaient bénéficié d’au moins une prescription de médicament non antirétroviral. Sur toute la durée de suivi, la dépense moyenne par patient était de 24,2 € par an, dont 22,1 € à la charge du patient. Après le cotrimoxazole (30,7 % des patients), les médicaments les plus fréquemment prescrits étaient le fer (29,2 % des patients), les antibiotiques (20,8 % des patients), les hypolipémiants (20,1 % des patients) et les antimycosiques généraux (16,3 % des patients). L’âge (RR: 1,01; IC 95 %: 1,00–1,07), le stade sida (RR: 2,15; IC 95 %: 1,61–4,19), l’anémie (RR: 2,02; IC 95 %: 2,10–5,41) et le nombre de comorbidités (RR: 2,45; IC 95 %: 2,10–5,41) étaient significativement associés à la prescription de médicaments non antirétroviraux. Conclusion Notre travail souligne la grande fréquence de la prescription des médicaments non antirétroviraux chez les patients vivant avec le VIH au Maroc; particulièrement à ceux qui sont plus âgés, anémiques à l’inclusion et ceux qui sont déjà au stade sida.

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Evolution of Drug Interactions With Antiretroviral Medication in People With HIV

Cited by 19 publications

References 27 publications

Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study

Coût et facteurs associés à la prescription des médicaments non antirétroviraux chez les patients infectés par le VIH sous thérapie antirétrovirale dans un hôpital de référence au Maroc

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