Recognition of Risk for Clinically Significant Drug Interactions among HIV‐Infected Patients Receiving Antiretroviral Therapy

Evans-Jones, John; Cottle, Lucy; Back, David; Gibbons, Sara; Beeching, Nicholas J.; Carey, Peter; Khoo, Saye

doi:10.1086/652149

Cited by 80 publications

(95 citation statements)

References 7 publications

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“…Despite the growing number of clinical trials assessing novel TB drugs, there is still not credible alternative to rifampicin-based therapy, and this remained the predominant cause of CSDIs in our study. Also TB is the first co-infected disease during the AIDS in Côte d'Ivoire [12].…”

Section: Discussionmentioning

confidence: 99%

“…For this study, we screened first, 560 consecutive patients According to the national Ivorian 2013 guidelines, first-line antiretroviral were defined as Tenofovir (TDF) or zidovudine (ZDV) plus lamivudine (3TC) plus nevirapine (NVP) or Efavirenz (EFV), and substitution with Tenofovir (TDF), abacavir (ABC) or didanosine (ddI) was allowed for toxicity. [12]. All the coprescribed drug pairs were screened for potential for DDSI using the Liverpool HIV Pharmacology Group website (www.hiv-druginteractions.org) [13].…”

Section: Study Populationmentioning

confidence: 99%

“…Further, PIs are substrates and/or inhibitors of drug transporters such as P-glycoprotein which may result in pharmacokinetic drug interactions [2][3][4]. Indeed, managing drug-drug interactions is one of the major challenges in the optimization of HIV therapy [5,6]. Also, using fixed dose combinations does not easily allow for personalization of therapy (e.g.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Role of Clinical Pharmacist to Reduce Risk in Patients Involving Antiretroviral Drugs at Abidjan Cohort

Atl¹,

Bat²,

Nac³

et al. 2016

J Pharma Care Health Sys

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of Clinical Pharmacist to Reduce Risk in Patients Involving Antiretroviral Drugs at Abidjan Cohort

Atl¹,

Bat²,

Nac³

et al. 2016

J Pharma Care Health Sys

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show abstract

“…46 Oleh karena itu, sebelum memulai terapi, perlu ditanyakan mengenai riwayat penggunaan obat-obatan agar terapi yang diberikan aman, akurat dan tepat waktu. Perlu juga dievaluasi mengenai gangguan kognitif pada pasien yang dapat berpengaruh terhadap kepatuhan berobat.…”

Section: Masalah Terkait Terapi Antiretroviralunclassified

HIV pada Geriatri HIV in Geriatrics

Ainun¹,

Yunihastuti²,

Roosheroe³

2017

JPDI

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ABSTRAKJumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial. PENDAHULUANJumlah pasien HIV berusia tua meningkat dari tahun ke tahun. Hal ini selain disebabkan oleh angka kejadian yang meningkat, juga disebabkan oleh terapi antiretroviral yang efektif sehingga angka harapan hidup bertambah. Sejak highly active anti-retroviral therapy (HAART) diperkenalkan pada tahun 1996 dan dimulai terapi anti retroviral kombinasi, pasien HIV yang terdiagnosis awal dan mendapat terapi antiretroviral dapat hidup seperti orang normal pada umumnya. 1 Pada penelitian yang dilakukan oleh Greene, dkk. 2 ditemukan rentang waktu terpanjang dari pasien terdiagnosis HIV hingga saat penelitian dilakukan mencapai 21 tahun. 2 Terapi antiretroviral menurunkan efek HIV dan peradangan kronik, namun tidak halnya dengan fungsi imunologis normal. Angka kesintasan pada pasien HIVusia lanjut yang mendapat terapi antiretroviral 30% lebih rendah dibanding populasi muda. Selain itu, kematian lebih cepat terjadi dalam empat tahun pertama semenjak terapi antiretroviral dimulai. 3 Belum diketahui pasti penyebabnya, namun diperkirakan perhatian yang kurang terhadap kepatuhan berobat, interaksi obat dan toksisitas, serta komorbid multipel memiliki pengaruh. Dengan demikian, dibutuhkan pendekatan tersendiri dalam menangani pasien HIVusia lanjut.

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“…So-called 'polypharmacy', usually defined as five or more medications, has been linked to decreased adherence, increased adverse drug reactions, more hospitalizations and an increase in mortality [4]. Evans et al recently found that 27% of HIV-infected patients had a clinically significant drug interaction between their highly active antiretroviral therapy (HAART) and another agent [5].We performed an audit to quantify polypharmacy in our large UK HIV-infected cohort using an HIV clinical care database. Using our HIV clinic database for patients attending in the year prior to 4 October 2013, we extracted demographics, antiretroviral regimen and list of all other medications.…”

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confidence: 99%

Quantifying polypharmacy in a large HIV‐infected cohort

2015

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Polypharmacy and the consequential risks of drug−drug interactions (DDIs) have been well documented [1] and have also been described in HIV infection [2,3]. As our patients become older with comorbidities, the number of coprescribed medications increases. So-called 'polypharmacy', usually defined as five or more medications, has been linked to decreased adherence, increased adverse drug reactions, more hospitalizations and an increase in mortality [4]. Evans et al. recently found that 27% of HIV-infected patients had a clinically significant drug interaction between their highly active antiretroviral therapy (HAART) and another agent [5].We performed an audit to quantify polypharmacy in our large UK HIV-infected cohort using an HIV clinical care database. Using our HIV clinic database for patients attending in the year prior to 4 October 2013, we extracted demographics, antiretroviral regimen and list of all other medications. We looked for evidence of potential DDIs, of which we present three here.Our cohort comprised 1415 patients, of whom 92 (6.5%) were aged over 60 years. Among 1395 patients with evaluable data, 1227 (88%) were on HAART and 988 (71%) reported taking other medications. The median number of coprescribed drugs was 2 [range 0 to 27; interquartile range (IQR) 4], with 21% of patients taking more than five drugs. A total of 574 different medicines were recorded (Table 1). The median number of antiretroviral formulations taken was 2 (range 0 − 5), with 303 (24% of treated) patients on a single tablet regimen. Thus, the total number of medications taken by our cohort was a median of 4 (range 0-28). In patients aged over 60 years, and in those with hepatitis C virus coinfection, the median number of coprescribed drugs rose to 4 [range 0-27 (IQR 1) and range 0-17 (IQR 2), respectively], and with the addition of their ARV regimen this rose to 6 total medications.In spite of this, we found little evidence of critical DDIs. No patients were found to be taking rilpivirine together with a proton pump inhibitor (PPI). One patient was recorded as taking a contra-indicated statin together with a protease inhibitor (PI); however, on case note review this interaction was found to have already been intercepted and a more appropriate statin prescribed. There were 78 patients identified who were coprescribed steroid preparations together with a PI. However, only seven of these were considered to be at risk of harm that had not been assessed and considered by the clinician.This audit highlights the ongoing potential for serious DDIs in HIV practice as a result of the degree of polypharmacy. Steroid coprescription is a concern, but two other concerning DDIs were not prevalent. Our findings rely on good data recording as well as a cooperation in good medicines reconciliation from both the clinician and the patient. We are introducing routine checking of our emergency care summary (ECS: an online record of prescriptions) in our out-patient clinical practice. In addition, we have asked primary care to add hospital-pres...

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Recognition of Risk for Clinically Significant Drug Interactions among HIV‐Infected Patients Receiving Antiretroviral Therapy

Cited by 80 publications

References 7 publications

Role of Clinical Pharmacist to Reduce Risk in Patients Involving Antiretroviral Drugs at Abidjan Cohort

Role of Clinical Pharmacist to Reduce Risk in Patients Involving Antiretroviral Drugs at Abidjan Cohort

HIV pada Geriatri HIV in Geriatrics

Quantifying polypharmacy in a large HIV‐infected cohort

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