1
|
Ojagbemi A. HIV Associated Neurocognitive Disorders Subsidence Through Citalopram Addition in Anti-retroviral Therapy (HANDS-CARE): A Concept Note. Front Neurol 2021; 12:658705. [PMID: 34381409 PMCID: PMC8350562 DOI: 10.3389/fneur.2021.658705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There is a pressing need to effectively manage HIV Associated Neurocognitive Disorders (HAND) in sub-Saharan Africa (SSA) where the burden is among the highest in the world. Contemporary approaches based on the use of Highly Active Antiretroviral Therapy (HAART) alone are inadequate interventions for HAND, especially in SSA where there is limited availability of the required combinations of HAART for effective central nervous system penetration and where many currently prescribed agents, including efavirenz, have neurotoxicity as a major drawback. This article reviews data supporting the rationale for additive citalopram in antiretroviral therapy as a latent approach to abate HAND. It proposes the conduct of a HIV Associated Neurocognitive Disorders Subsidence through Citalopram addition in Anti-Retroviral therapy (HANDS-CARE) pilot feasibility trial (RCT) to assess whether the adjunctive use of citalopram, a widely prescribed serotonergic antidepressant, will lead to a meaningful improvement in neurocognitive functioning and quality of life in patients with HAND who are receiving HAART. A preliminarily feasible and efficacy-suggesting HANDS-CARE trial could generate statistical, clinical and operational data necessary to design and conduct a future definitive RCT. If successful, this intervention will be applicable to resource-limited settings as well as developed countries. Effective management of HAND will improve the quality of life of HIV patients, and reduce the cost of managing the disease.
Collapse
Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
2
|
Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies. CNS Drugs 2021; 35:345-384. [PMID: 33866523 PMCID: PMC8053373 DOI: 10.1007/s40263-021-00811-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
As many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug-drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug-drug interactions resulting in additive or synergistic toxicity; (3) drug-disease interactions according to stage and severity of the disease; and (4) pharmacogenetic issues associated with polymorphisms of cytochrome P450 isoenzymes. In this review, we summarise the available literature on relevant drug interactions between psychotropic agents and COVID-19 therapies, providing practical clinical recommendations and potential management strategies according to severity of illness and clinical scenario.
Collapse
|
3
|
Molas E, Luque S, Retamero A, Echeverría-Esnal D, Guelar A, Montero M, Guerri R, Sorli L, Lerma E, Villar J, Knobel H. Frequency and severity of potential drug interactions in a cohort of HIV-infected patients Identified through a Multidisciplinary team. HIV CLINICAL TRIALS 2017; 19:1-7. [PMID: 29179644 DOI: 10.1080/15284336.2017.1404690] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Interactions between antiretroviral treatment (ART) and comedications are a concern in HIV-infected patients. This study aimed to determine the frequency and severity of potential drug-drug interactions (PDDIs) with ART in our setting. METHODS Observational study by a multidisciplinary team in 1259 consecutive HIV patients (March 2015-September 2016). Data on demographics, toxic habits, comorbidities, and current ART were collected. A structured questionnaire recorded concomitant medications (including occasional and over-the-counter drugs). PDDIs were classified into four categories: (1) no interactions, (2) mild (clinically non-significant), (3) moderate (requiring close monitoring or drug modification/dose adjustment), and (4) severe (contraindicated). STATISTICAL ANALYSIS chi-square test, logistic regression analysis. RESULTS In total, 881 (70%) patients took comedication, and 563 (44.7%) had ≥ PDDI. Forty-one comedicated patients (4.6%) had severe and 522 (59.2%) moderate PDDIs. Moderate PDDIs mainly involved cardiovascular (53.8%) and central nervous system (40.2%) drugs. Independent risk factors for PDDIs were ART containing a boosted protease inhibitor (odds ratio [OR]=9.11, 95% confidence interval [CI] 5.15-16.11; p = 0.0001) and/or non-nucleoside reverse transcriptase (NNRTI) (OR = 4.34, 95%CI 2.49-7.55; p = 0.0001), HCV co-infection (OR = 3.26, 95%CI 2.15-4.93; p = 0.0001), and use of two or more comedications (OR = 3.36, 95%CI 2.27-4.97; p = 0.0001). Adherence and effectiveness of ART were similar in patients with and without PDDIs. The team made 133 recommendations related to comedications (drug change or dose adjustment) or ART (drug switch or change in administration schedule). CONCLUSIONS Systematic evaluation detected a significant percentage of PDDIs requiring an intervention in HIV patients on ART. Monitoring and advice about drug-drug interactions should be part of routine practice.
Collapse
Affiliation(s)
- E Molas
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - S Luque
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Retamero
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - D Echeverría-Esnal
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Guelar
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - M Montero
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - R Guerri
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - L Sorli
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - E Lerma
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - J Villar
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - H Knobel
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| |
Collapse
|
4
|
Santos WMD, Secoli SR, Padoin SMDM. Potential drug interactions in patients given antiretroviral therapy. Rev Lat Am Enfermagem 2016; 24:e2832. [PMID: 27878224 PMCID: PMC5173305 DOI: 10.1590/1518-8345.1193.2832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/14/2016] [Indexed: 01/25/2023] Open
Abstract
Objective to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.
Collapse
Affiliation(s)
| | - Silvia Regina Secoli
- PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Stela Maris de Mello Padoin
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| |
Collapse
|
5
|
Abstract
Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated with the HIV illness. Evidences exist to support the importance of improving the identification of depressive symptoms and their adequate treatment. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality. By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, Cochrane Library), the review discusses the epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches, including psychosocial interventions, psychopharmacology as well as HIV-specific health psychology health service models.
Collapse
|
6
|
Zimpel RR, Fleck MP. Depression as a major impact on the quality of life of HIV-positive Brazilians. PSYCHOL HEALTH MED 2013; 19:47-58. [DOI: 10.1080/13548506.2013.772302] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
Owusu K, Patel R, Chung AM. A review of human immunodeficiency virus (HIV) and postpartum depression. Ment Health Clin 2013. [DOI: 10.9740/mhc.n140593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Depression is common among HIV-infected women, predicts treatment non-adherence, and may impact mother to daughter (vertical) transmission of HIV. A majority of women who develop HIV are of child-bearing age, and are at risk for postpartum depression (PPD). A literature review was performed to analyze the literature regarding PPD in HIV-positive women. This review specifically looked at literature regarding the incidence, risk factors, outcomes, and treatment of PPD in HIV-positive women compared to the general population. While existing literature is limited, it seems to imply that there is no difference between HIV-positive women and unaffected women when it comes to PPD incidence or risk factors. A majority of studies did conclude that routine screenings are needed for depressive symptoms in HIV-positive women.
Collapse
Affiliation(s)
- Kent Owusu
- Auburn University, Harrison School of Pharmacy
| | - Ravin Patel
- Auburn University, Harrison School of Pharmacy
| | - Allison M. Chung
- Associate Professor for Pharmacy Practice, Auburn University, Harrison School of Pharmacy, Adjunct Associate Professor for Pediatrics, University of South Alabama, School of Medicine
| |
Collapse
|
8
|
Jernigan MG, Kipp GM, Rather A, Jenkins MT, Chung AM. Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications. Ment Health Clin 2013. [DOI: 10.9740/mhc.n139874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medications used in the treatment of human immunodeficiency virus (HIV) often have drug-drug interactions which complicate treatment of psychiatric illnesses in HIV-infected patients. Protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) are the two classes of HIV medications most likely to be involved with interactions, with the majority occurring via the cytochrome P450 (CYP450) system. These interactions can result in either increased or decreased exposure to psychotropic and antiretroviral medications, often requiring dosage adjustments and increased monitoring. This article reviews some of the major drug interactions with antiretroviral agents.
Collapse
|
9
|
Morrison SD, Banushi VH, Sarnquist C, Gashi VH, Osterberg L, Maldonado Y, Harxhi A. Levels of self-reported depression and anxiety among HIV-positive patients in Albania: a cross-sectional study. Croat Med J 2012; 52:622-8. [PMID: 21990080 PMCID: PMC3195971 DOI: 10.3325/cmj.2011.52.622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To gain an initial perspective of mental health issues facing the Human Immunodeficiency Virus (HIV)-positive population at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic. Methods From June-August 2009, we conducted semi-structured interviews with 79 patients (93% response rate) at the UHCT HIV/AIDS Ambulatory Clinic. The interviews assessed patient-reported histories of mental health diagnoses, patients’ demographics, and current emotional health status. Results The percentage of patients who reported a history of diagnosis of depression or anxiety was high – 62.3% and 82.3%, respectively. Factors associated with a history of depression included having been diagnosed with anxiety (P < 0.001), having a higher number of barriers to care (P < 0.001), having a higher number of current medical and social needs (P < 0.001), or having not obtained antiretroviral therapy (ART) abroad (P = 0.004). Factors associated with a history of anxiety included having been on first-line ART (P = 0.008), having been diagnosed with HIV for shorter periods of time (P = 0.043), having been diagnosed with depression (P < 0.001), having a higher number of current medical and social needs (P = 0.035), or having not obtained ART abroad (P = 0.003). Conclusions Mental health problems are widespread among the known HIV-positive patient population in Albania. The high prevalences of anxiety and depression and of dual diagnoses of these conditions suggest the need for more mental health care for HIV-positive patients in Albania.
Collapse
Affiliation(s)
- Shane D Morrison
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305-0495, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Gayner B, Esplen MJ, DeRoche P, Wong J, Bishop S, Kavanagh L, Butler K. A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV. J Behav Med 2011; 35:272-85. [DOI: 10.1007/s10865-011-9350-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 04/22/2011] [Indexed: 11/29/2022]
|
11
|
Salemi J, Obregon DF, Cobb A, Reed S, Sadic E, Jin J, Fernandez F, Tan J, Giunta B. Flipping the switches: CD40 and CD45 modulation of microglial activation states in HIV associated dementia (HAD). Mol Neurodegener 2011; 6:3. [PMID: 21223591 PMCID: PMC3030526 DOI: 10.1186/1750-1326-6-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 01/11/2011] [Indexed: 12/21/2022] Open
Abstract
Microglial dysfunction is associated with the pathogenesis and progression of a number of neurodegenerative disorders including HIV associated dementia (HAD). HIV promotion of an M1 antigen presenting cell (APC) - like microglial phenotype, through the promotion of CD40 activity, may impair endogenous mechanisms important for amyloid- beta (Aβ) protein clearance. Further, a chronic pro-inflammatory cycle is established in this manner. CD45 is a protein tyrosine phosphatase receptor which negatively regulates CD40L-CD40-induced microglial M1 activation; an effect leading to the promotion of an M2 phenotype better suited to phagocytose and clear Aβ. Moreover, this CD45 mediated activation state appears to dampen harmful cytokine production. As such, this property of microglial CD45 as a regulatory "off switch" for a CD40-promoted M1, APC-type microglia activation phenotype may represent a critical therapeutic target for the prevention and treatment of neurodegeneration, as well as microglial dysfunction, found in patients with HAD.
Collapse
Affiliation(s)
- Jon Salemi
- Department of Psychiatry and Neurosciences, Neuroimmunology Laboratory, University of South Florida, College of Medicine, Tampa, FL 33613, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Antipsychotic-induced priapism in an HIV patient: a cytochrome P450-mediated drug interaction. Int J Emerg Med 2010; 3:81-4. [PMID: 20606815 PMCID: PMC2885261 DOI: 10.1007/s12245-010-0175-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 02/25/2010] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND With upwards of 48% of human immunodeficiency virus (HIV)-infected persons having a probable psychiatric disorder, the possibility of cross-class drug interactions causing adverse effects or fatalities exists. AIMS This report discusses an emergent case of low-flow priapism caused by an interaction between a previously prescribed combination protease inhibitor (PI) and newly added antipsychotic medications. METHODS A 50-year-old HIV-positive man on highly active antiretroviral therapy (HAART), including the combination PI, lopinavir/ritonavir (Kaletra((R))), experienced an episode of priapism hours after beginning two new antipsychotic medications. Quetiapine (Seroquel((R))) and perphenazine (Trilafon((R))) were added to treat a diagnosed schizoaffective disorder. RESULTS The patient presented to the emergency department complaining of a constant, painful erection lasting approximately 42 h. Treatment with intracavernous ephedrine, irrigation, and aspiration helped achieve detumescence. CONCLUSION This case displays the immediate and detrimental effects due to the addition of antipsychotic medications to previously altered cytochrome P450 (CYP450) enzyme levels. The inhibition of CYP450 enzymes 3A4 and 2D6 by the combination PI, lopinavir/ritonavir, was likely the major culprit in causing greater than expected free levels of perphenazine and quetiapine resulting in priapism.
Collapse
|
13
|
Vögele C. Psychische Störungen bei HIV-Infektion und Aids. PSYCHOTHERAPEUT 2010. [DOI: 10.1007/s00278-010-0749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Nakimuli-Mpungu E, Mutamba B, Nshemerirwe S, Kiwuwa M, Musisi S. Effect of HIV infection on time to recovery from an acute manic episode. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2010; 2:185-9. [PMID: 22096397 PMCID: PMC3218699 DOI: 10.2147/hiv.s9978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Understanding factors affecting the time to recovery from acute mania is critical in the management of manic syndromes. The aim of this study was to determine the effect of HIV infection on time to recovery from acute mania. METHODS We performed a retrospective study in which medical charts of individuals who were treated for acute mania were reviewed. Survival analysis with Cox regression models were used to compare time to recovery from an acute manic episode between human immunodeficiency virus (HIV)-positive individuals and HIV-negative individuals. RESULTS Median survival time was one week for HIV-positive individuals and more than four weeks for HIV-negative individuals (χ(2) = 18.4, P value = 0.000). HIV infection was the only marginally significant independent predictor of survival probability on the acute admission ward (hazards ratio 2.87, P = 0.06). CONCLUSION Acute mania in HIV-infected persons responds faster to psychotropic drugs compared with that in HIV-negative persons.
Collapse
Affiliation(s)
- E Nakimuli-Mpungu
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
15
|
Abstract
Since the earliest days of the AIDS epidemic, clinicians have been concerned about the prevalence of depression among their patients. Epidemiologists, psychiatrists, psychologists, sociologists, and a broad array of other specialists have studied this topic, trying to determine the prevalence of depressive disorders and depressive symptoms as well as antecedents, correlates, and consequences. This review addresses the methodologic difficulties in determining depression prevalence, major findings regarding rates of disorder and correlates among different segments of the HIV community, effects of depression on HIV illness progression, psychopharmacologic and psychotherapeutic treatment findings, and behavioral effects of depression, such as its impact on medication adherence, employment, and risk behavior. Finally, the article summarizes international studies of depression prevalence in developing countries and the challenges regarding cross-national diagnostic definitions and measures.
Collapse
Affiliation(s)
- Judith G Rabkin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 51, New York, NY 10032, USA.
| |
Collapse
|
16
|
|