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Sonti S, Tyagi K, Pande A, Daniel R, Sharma AL, Tyagi M. Crossroads of Drug Abuse and HIV Infection: Neurotoxicity and CNS Reservoir. Vaccines (Basel) 2022; 10:vaccines10020202. [PMID: 35214661 PMCID: PMC8875185 DOI: 10.3390/vaccines10020202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Drug abuse is a common comorbidity in people infected with HIV. HIV-infected individuals who abuse drugs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A modest proportion of HIV-infected individuals develop HIV-associated neurocognitive issues, the severity of which further increases with drug abuse. Moreover, the tendency of the virus to go into latency in certain cellular reservoirs again complicates the elimination of HIV and HIV-associated illnesses. Antiretroviral therapy (ART) successfully decreased the overall viral load in infected people, yet it does not effectively eliminate the virus from all latent reservoirs. Although ART increased the life expectancy of infected individuals, it showed inconsistent improvement in CNS functioning, thus decreasing the quality of life. Research efforts have been dedicated to identifying common mechanisms through which HIV and drug abuse lead to neurotoxicity and CNS dysfunction. Therefore, in order to develop an effective treatment regimen to treat neurocognitive and related symptoms in HIV-infected patients, it is crucial to understand the involved mechanisms of neurotoxicity. Eventually, those mechanisms could lead the way to design and develop novel therapeutic strategies addressing both CNS HIV reservoir and illicit drug use by HIV patients.
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Affiliation(s)
- Shilpa Sonti
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
| | - Kratika Tyagi
- Department of Biotechnology, Banasthali Vidyapith, Vanasthali, Jaipur 304022, Rajasthan, India;
| | - Amit Pande
- Cell Culture Laboratory, ICAR-Directorate of Coldwater Fisheries Research, Bhimtal, Nainital 263136, Uttarakhand, India;
| | - Rene Daniel
- Farber Hospitalist Service, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Adhikarimayum Lakhikumar Sharma
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
| | - Mudit Tyagi
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
- Correspondence: ; Tel.: +1-215-503-5157 or +1-703-909-9420
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Novel Phenethylamines and Their Potential Interactions With Prescription Drugs: A Systematic Critical Review. Ther Drug Monit 2021; 42:271-281. [PMID: 32022784 DOI: 10.1097/ftd.0000000000000725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The novel phenethylamines 4-fluoroamphetamine (4-FA) and 2,5-dimethoxy-4-bromophenethylamine (2C-B) fall in the top 10 most used new psychoactive substances (NPSs) among high-risk substance users. Various phenethylamines and NPS are also highly used in populations with mental disorders, depression, or attention deficit hyperactivity disorder (ADHD). Moreover, NPS use is highly prevalent among men and women with risky sexual behavior. Considering these specific populations and their frequent concurrent use of drugs, such as antidepressants, ADHD medication, and antiretrovirals, reports on potential interactions between these drugs, and phenethylamines 4-FA and 2C-B, were reviewed. METHODS The authors performed a systematic literature review on 4-FA and 2C-B interactions with antidepressants (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, bupropion, venlafaxine, phenelzine, moclobemide, and tranylcypromine), ADHD medications (atomoxetine, dexamphetamine, methylphenidate, and modafinil), and antiretrovirals. RESULTS Limited literature exists on the pharmacokinetics and drug-drug interactions of 2C-B and 4-FA. Only one case report indicated a possible interaction between 4-FA and ADHD medication. Although pharmacokinetic interactions between 4-FA and prescription drugs remain speculative, their pharmacodynamic points toward interactions between 4-FA and ADHD medication and antidepressants. The pharmacokinetic and pharmacodynamic profile of 2C-B also points toward such interactions, between 2C-B and prescription drugs such as antidepressants and ADHD medication. CONCLUSIONS A drug-drug (phenethylamine-prescription drug) interaction potential is anticipated, mainly involving monoamine oxidases for 2C-B and 4-FA, with monoamine transporters being more specific to 4-FA.
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Desai N, Burns L, Gong Y, Zhi K, Kumar A, Summers N, Kumar S, Cory TJ. An update on drug-drug interactions between antiretroviral therapies and drugs of abuse in HIV systems. Expert Opin Drug Metab Toxicol 2020; 16:1005-1018. [PMID: 32842791 DOI: 10.1080/17425255.2020.1814737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION While considerable progress has been made in the fight against HIV/AIDS, to date there has not been a cure, and millions of people around the world are currently living with HIV/AIDS. People living with HIV/AIDS have substance abuse disorders at higher rates than non-infected individuals, which puts them at an increased risk of drug-drug interactions. AREAS COVERED Potential drug-drug interactions are reviewed for a variety of potential drugs of abuse, both licit and illicit. These drugs include alcohol, cigarettes or other nicotine delivery systems, methamphetamine, cocaine, opioids, and marijuana. Potential interactions include decreased adherence, modulation of drug transporters, or modulation of metabolic enzymes. We also review the relative incidence of the use of these drugs of abuse in People living with HIV/AIDS. EXPERT OPINION Despite considerable improvements in outcomes, disparities in outcomes between PLWHA who use drugs of abuse, vs those who do not still exist. It is of critical necessity to improve outcomes in these patients and to work with them to stop abusing drugs of abuse.
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Affiliation(s)
- Nuti Desai
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Leah Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Yuqing Gong
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Kaining Zhi
- Plough Center for Sterile Drug Delivery Solutions, University of Tennessee Health Science Center , Memphis, TN, USA
| | - Asit Kumar
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Nathan Summers
- Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine , Memphis, TN, USA
| | - Santosh Kumar
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Theodore J Cory
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
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Truter I, Gaida R, Grobler C. OUTCOMES OF PEOPLE LIVING WITH HIV IN TWO PUBLIC-SECTOR PSYCHIATRIC FACILITIES IN THE EASTERN CAPE USING EFAVIRENZ-CONTAINING REGIMENS. Afr J Infect Dis 2020; 14:10-15. [PMID: 33884345 PMCID: PMC8047287 DOI: 10.21010/ajid.v14i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background: People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen. Materials and Methods: A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed. Results: A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen. Conclusion: Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms.
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Affiliation(s)
- Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Razia Gaida
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Christoffel Grobler
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa.,Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
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Cotto B, Natarajanseenivasan K, Langford D. HIV-1 infection alters energy metabolism in the brain: Contributions to HIV-associated neurocognitive disorders. Prog Neurobiol 2019; 181:101616. [PMID: 31108127 PMCID: PMC6742565 DOI: 10.1016/j.pneurobio.2019.101616] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/17/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022]
Abstract
The brain is particularly sensitive to changes in energy supply. Defects in glucose utilization and mitochondrial dysfunction are hallmarks of nearly all neurodegenerative diseases and are also associated with the cognitive decline that occurs as the brain ages. Chronic neuroinflammation driven by glial activation is commonly implicated as a contributing factor to neurodegeneration and cognitive impairment. Human immunodeficiency virus-1 (HIV-1) disrupts normal brain homeostasis and leads to a spectrum of HIV-associated neurocognitive disorders (HAND). HIV-1 activates stress responses in the brain and triggers a state of chronic neuroinflammation. Growing evidence suggests that inflammatory processes and bioenergetics are interconnected in the propagation of neuronal dysfunction. Clinical studies of people living with HIV and basic research support the notion that HIV-1 creates an environment in the CNS that interrupts normal metabolic processes at the cellular level to collectively alter whole brain metabolism. In this review, we highlight reports of abnormal brain metabolism from clinical studies and animal models of HIV-1. We also describe diverse CNS cell-specific changes in bioenergetics associated with HIV-1. Moreover, we propose that attention should be given to adjunctive therapies that combat sources of metabolic dysfunction as a mean to improve and/or prevent neurocognitive impairments.
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Affiliation(s)
- Bianca Cotto
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
| | - Kalimuthusamy Natarajanseenivasan
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
| | - Dianne Langford
- Lewis Katz School of Medicine at Temple University, Department of Neuroscience and Center for Neurovirology, Philadelphia, PA, 19140, USA.
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Mathur S, Roberts-Toler C, Tassiopoulos K, Goodkin K, McLaughlin M, Bares S, Koletar SL, Erlandson KM. Detrimental Effects of Psychotropic Medications Differ by Sex in Aging People With HIV. J Acquir Immune Defic Syndr 2019; 82:88-95. [PMID: 31169770 PMCID: PMC6692226 DOI: 10.1097/qai.0000000000002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH. METHODS Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years. RESULTS Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women. CONCLUSIONS Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.
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Affiliation(s)
- Swati Mathur
- University of Colorado, Department of Medicine, Aurora, CO
| | - Carla Roberts-Toler
- Harvard T. H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | | | - Karl Goodkin
- East Tennessee State University, Department of Psychiatry and Behavioral Sciences, Johnson City, TN
| | - Milena McLaughlin
- Northwestern Memorial Hospital, Chicago, IL
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL
| | - Sara Bares
- University of Nebraska Medical Center, Department of Medicine, Omaha, NB
| | - Susan L. Koletar
- The Ohio State University Medical Center, Department of Medicine, Columbus, OH
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Predicting inadequate postoperative pain management in depressed patients: A machine learning approach. PLoS One 2019; 14:e0210575. [PMID: 30726237 PMCID: PMC6364959 DOI: 10.1371/journal.pone.0210575] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/26/2018] [Indexed: 11/19/2022] Open
Abstract
Widely-prescribed prodrug opioids (e.g., hydrocodone) require conversion by liver enzyme CYP-2D6 to exert their analgesic effects. The most commonly prescribed antidepressant, selective serotonin reuptake inhibitors (SSRIs), inhibits CYP-2D6 activity and therefore may reduce the effectiveness of prodrug opioids. We used a machine learning approach to identify patients prescribed a combination of SSRIs and prodrug opioids postoperatively and to examine the effect of this combination on postoperative pain control. Using EHR data from an academic medical center, we identified patients receiving surgery over a 9-year period. We developed and validated natural language processing (NLP) algorithms to extract depression-related information (diagnosis, SSRI use, symptoms) from structured and unstructured data elements. The primary outcome was the difference between preoperative pain score and postoperative pain at discharge, 3-week and 8-week time points. We developed computational models to predict the increase or decrease in the postoperative pain across the 3 time points by using the patient’s EHR data (e.g. medications, vitals, demographics) captured before surgery. We evaluate the generalizability of the model using 10-fold cross-validation method where the holdout test method is repeated 10 times and mean area-under-the-curve (AUC) is considered as evaluation metrics for the prediction performance. We identified 4,306 surgical patients with symptoms of depression. A total of 14.1% were prescribed both an SSRI and a prodrug opioid, 29.4% were prescribed an SSRI and a non-prodrug opioid, 18.6% were prescribed a prodrug opioid but were not on SSRIs, and 37.5% were prescribed a non-prodrug opioid but were not on SSRIs. Our NLP algorithm identified depression with a F1 score of 0.95 against manual annotation of 300 randomly sampled clinical notes. On average, patients receiving prodrug opioids had lower average pain scores (p<0.05), with the exception of the SSRI+ group at 3-weeks postoperative follow-up. However, SSRI+/Prodrug+ had significantly worse pain control at discharge, 3 and 8-week follow-up (p < .01) compared to SSRI+/Prodrug- patients, whereas there was no difference in pain control among the SSRI- patients by prodrug opioid (p>0.05). The machine learning algorithm accurately predicted the increase or decrease of the discharge, 3-week and 8-week follow-up pain scores when compared to the pre-operative pain score using 10-fold cross validation (mean area under the receiver operating characteristic curve 0.87, 0.81, and 0.69, respectively). Preoperative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. We provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. Current prescribing patterns indicate that prescribers may not account for this interaction when choosing an opioid. The study results imply that prescribers might instead choose direct acting opioids (e.g. oxycodone or morphine) in depressed patients on SSRIs.
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Aharonovich E, Sarvet A, Stohl M, DesJarlais D, Tross S, Hurst T, Urbina A, Hasin D. Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement. J Subst Abuse Treat 2016; 74:71-79. [PMID: 28132704 DOI: 10.1016/j.jsat.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/14/2016] [Accepted: 12/28/2016] [Indexed: 01/18/2023]
Abstract
AIMS In HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition. DESIGN Participants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back. FINDINGS Across all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control. CONCLUSIONS Brief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.
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Affiliation(s)
- Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Sarvet
- New York State Psychiatric Institute, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Don DesJarlais
- Icahn School of Medicine, at Mount Sinai New York, New York, USA
| | - Susan Tross
- New York State Psychiatric Institute, New York, NY, USA; HIV Center for Clinical and Behavioral Studies/Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Teresa Hurst
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Antonio Urbina
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Prevalence of recreational drug use is indiscriminate across antiretroviral regimens of differing drug-drug interactions among MSM. AIDS 2016; 30:810-2. [PMID: 26913713 DOI: 10.1097/qad.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stolbach A, Paziana K, Heverling H, Pham P. A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products. J Med Toxicol 2015; 11:326-41. [PMID: 26036354 PMCID: PMC4547966 DOI: 10.1007/s13181-015-0465-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
For many patients today, HIV has become a chronic disease. For those patients who have access to and adhere to lifelong antiretroviral (ARV) therapy, the potential for drug-drug interactions has become a real and life-threatening concern. It is known that most ARV drug interactions occur through the cytochrome P450 (CYP) pathway. Medications for comorbid medical conditions, holistic supplements, and illicit drugs can be affected by CYP inhibitors and inducers and have the potential to cause harm and toxicity. Protease inhibitors (PIs) tend to inhibit CYP3A4, while most non-nucleoside reverse transcriptase inhibitors (NNRTIs) tend to induce the enzyme. As such, failure to adjust the dose of co-administered medications, such as statins and steroids, may lead to serious complications including rhabdomyolysis and hypercortisolism, respectively. Similarly, gastric acid blockers can decrease several ARV absorption, and warfarin doses may need to be adjusted to maintain therapeutic concentrations. Illicit drugs such as methylenedioxymethamphetamine (MDMA, "ecstasy") in combination with PIs lead to increased toxicity, while the concomitant administration of sedative drugs such as midazolam and alprazolam in patients taking PIs can result in prolonged sedation, delayed recovery, and increased length of stay. Even supplements like St. John's Wort can alter PI concentrations. In theory, any drug that is metabolized by CYP has potential for a pharmacokinetic drug-drug interaction with all PIs, cobicistat, and most NNRTIs. When adding a new medication to an ARV regimen, use of a drug-drug interaction software and/or consultation with a clinical pharmacist/pharmacologist or HIV specialist is recommended.
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Affiliation(s)
- Andrew Stolbach
- />Department of Emergency Medicine, Johns Hopkins Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287 USA
| | - Karolina Paziana
- />Department of Emergency Medicine, Johns Hopkins Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287 USA
| | - Harry Heverling
- />Department of Emergency Medicine, Johns Hopkins Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287 USA
| | - Paul Pham
- />Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, 4th floor, Baltimore, MD 21205 USA
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Bracchi M, Stuart D, Castles R, Khoo S, Back D, Boffito M. Increasing use of 'party drugs' in people living with HIV on antiretrovirals: a concern for patient safety. AIDS 2015; 29:1585-92. [PMID: 26372268 DOI: 10.1097/qad.0000000000000786] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Use of 'party drugs', a particular set of recreational drugs used in the context of 'ChemSex', is frequent among MSM living with HIV. A recently published observational study showed that more than half of HIV-infected MSM interviewed reported use of illicit substances in the previous 3 months, with frequent concomitant use of three or more drugs. These substances are a combination of 'club drugs' (methylenedioxymethamphetamine, gamma-hydroxybutyrate, ketamine, benzodiazepine) and drugs that are more specifically used in a sexualized context (methamphetamine, mephedrone, poppers and erectile dysfunction agents). Although formal data on pharmacokinetic or pharmacodynamic interactions between recreational drugs and antiretroviral agents are lacking, information regarding potentially toxic interactions can be theorized or sometimes conclusions may be drawn from case studies and cohort observational studies. However, the risk of coadministering party drugs and antiretrovirals should not be overestimated. The major risk for a drug-drug interaction is when using ritonavir-boosting or cobicistat-boosting agents, and maybe some nonnucleoside reverse transcriptase inhibitors. Knowledge of the metabolic pathways of 'party drugs' may help in advising patients on which illicit substances have a high potential for drug-drug interactions, as this is not the case for all.
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Affiliation(s)
- Margherita Bracchi
- aSt Stephen's AIDS Trust bDean Street Clinic, Chelsea and Westminster Hospital cJonathan Mann Clinic, Homerton Hospital dUniversity of Liverpool, Liverpool eImperial College, London, UK
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12
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Manzardo C, Tuset M, Miró JM, Gatell JM. Interacciones graves o potencialmente letales entre antirretrovirales y otros medicamentos. Enferm Infecc Microbiol Clin 2015; 33:e15-30. [DOI: 10.1016/j.eimc.2014.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/12/2014] [Accepted: 02/23/2014] [Indexed: 12/31/2022]
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Bruce RD, Altice FL, Friedland GH. Pharmacokinetic drug interactions between drugs of abuse and antiretroviral medications: implications and management for clinical practice. Expert Rev Clin Pharmacol 2014; 1:115-27. [PMID: 24410515 DOI: 10.1586/17512433.1.1.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Substance abuse and HIV/AIDS are two of the most serious, yet treatable diseases worldwide. Global access to HIV treatment continues to expand. In settings where both active illicit drug use and HIV treatment are concurrent, potentional problematic pharmacokinetic drug interactions may arise and complicate therapy. Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between only a few drugs of abuse and approved antiretroviral therapies. Important pharmacokinetic drug interactions have been described for benzodiazepines, 3,4-methylenedioxymethamphetamine, methadone and buprenorphine; however, most have not been studied and few well-controlled studies have been conducted to adequately address the clinical implications of these interactions. The metabolism of drugs of abuse, description of the known interactions, and clinical implications and management of these interactions are reviewed. Certain interactions between drugs of abuse and antiretroviral therapies are known and others are likely based upon shared metabolic pathways. These may result in important clinical consequences. To optimize care, clinicians must be alert, knowledgeable about known and possible interactions and equipped to clinically manage the medical consequences. Moreover, there is considerable need for carefully controlled studies in this important and emerging area.
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Affiliation(s)
- R Douglas Bruce
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06511, USA.
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Davis GP, Surratt HL, Levin FR, Blanco C. Antiretroviral medication: an emerging category of prescription drug misuse. Am J Addict 2013; 23:519-25. [PMID: 24102874 DOI: 10.1111/j.1521-0391.2013.12107.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/29/2013] [Accepted: 08/10/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prescription drug abuse has been a focus of public health concern over the past two decades with many studies addressing patterns of narcotic analgesic abuse and diversion. Most research in this domain has centered on controlled substances with known abuse liability. However, the scientific literature has been virtually silent regarding other prescribed medications with previously undocumented addictive potential, such as antiretroviral (ARV) medications for treatment of human immunodeficiency virus. METHODS This article reviews the available evidence that suggests a growing problem of ARV diversion and abuse and explores the reasons for the misuse of these medications based on the theoretical neuropsychiatric effects of ARVs and the drug-drug interactions between ARVs and other drugs of abuse. RESULTS Review of media reports and qualitative studies suggest that ARV medications are emerging drugs of abuse. Claims about the psychoactive effects of ARV medications are supported by scientific case reports. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE This article reviews the evidence to date of an emerging problem of diversion and misuse of ARV medications for recreational purposes. Implications of ARV misuse and diversion are discussed with suggestions for future research and intervention.
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Affiliation(s)
- Glen P Davis
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York
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15
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Fontes AS, Gonçalves JF. Pain treatment in patients infected with human immunodeficiency virus in later stages: pharmacological aspects. Am J Hosp Palliat Care 2013; 31:194-201. [PMID: 23503562 DOI: 10.1177/1049909113480553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain is a common and debilitating symptom of human immunodeficiency virus (HIV) disease, although it is often underestimated and undertreated, especially in HIV-infected intravenous drug users. It is more likely to occur in the later stages of the HIV disease, where it assumes particular significance, especially in terminally ill patients. However, its successful management is possible, though the goal of effective therapy is hampered by the side effects of highly active antiretroviral therapy and drug-drug interactions. In order to appraise these issues, a search in MEDLINE database was conducted. Book reviews and a search on relevant Web sites were also included. Treatment of HIV is itself very complex and becomes even more difficult when palliative therapy is added. Protease inhibitors, mainly ritonavir, and nonnucleoside reverse transcriptase inhibitors have higher interaction potential, due to their inducer or inhibitory actions on cytochrome P450, posing a risk when coadministered with palliative treatments; so, better outcomes can be achieved with knowledge of pharmacological aspects.
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16
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English BA, Dortch M, Ereshefsky L, Jhee S. Clinically significant psychotropic drug-drug interactions in the primary care setting. Curr Psychiatry Rep 2012; 14:376-90. [PMID: 22707017 PMCID: PMC4335312 DOI: 10.1007/s11920-012-0284-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the number of psychotropic medications prescribed. Along with the increased utilization of psychotropic medications, considerable variability is noted in the prescribing patterns of primary care providers and psychiatrists. Because psychiatric patients also suffer from a number of additional medical comorbidities, the increased utilization of psychotropic medications presents an elevated risk of clinically significant drug interactions in these patients. While life-threatening drug interactions are rare, clinically significant drug interactions impacting drug response or appearance of serious adverse drug reactions have been documented and can impact long-term outcomes. Additionally, the impact of genetic variability on the psychotropic drug's pharmacodynamics and/or pharmacokinetics may further complicate drug therapy. Increased awareness of clinically relevant psychotropic drug interactions can aid clinicians to achieve optimal therapeutic outcomes in patients in the primary care setting.
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Affiliation(s)
- Brett A English
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-8300, USA.
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17
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Abstract
PURPOSE OF REVIEW To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV. RECENT FINDINGS Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices. Robust data exists linking the use of club drugs by the men who have sex with men population with spread of HIV, but this data in other at-risk populations (e.g. African Americans) is not as robust. Additional research is needed to identify the rates of transmission among adolescents and emerging adults, as well as knowledge, attitudes, beliefs, and practices that affect HIV transmission in this population. SUMMARY Use of club drugs by adolescents and emerging adults contributes to the current rate of HIV transmission among this age group.
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Affiliation(s)
- Matthew D Zuckerman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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18
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Kipp AM, Desruisseau AJ, Qian HZ. Non-injection drug use and HIV disease progression in the era of combination antiretroviral therapy. J Subst Abuse Treat 2011; 40:386-96. [PMID: 21353444 DOI: 10.1016/j.jsat.2011.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 10/11/2010] [Accepted: 01/06/2011] [Indexed: 11/18/2022]
Abstract
Little is known about the effects of non-injection drug use (NIDU) on HIV antiretroviral treatment outcomes. We conducted a systematic literature search and identified nine publications from prospective cohort studies investigating the relationship between NIDU and clinical HIV disease progression. Hazard ratios from studies estimating the effect of drug use on time to AIDS-related mortality ranged from 0.89 to 3.61, and only two of these were statistically significant. Hazard ratios from studies assessing time to an AIDS-defining event ranged from 1.19 to 2.51, with 8 of the 14 estimates falling between 1.55 and 1.65 regardless of drug use definition and measurement of use or frequency. It is suggested that NIDU may have a moderate effect of increasing the risk of progression to AIDS, but its impact on AIDS-related mortality is uncertain. NIDU may affect HIV antiretroviral treatment outcomes primarily through interaction with antiretroviral therapy and, to a lesser extent, through immune modulation and deterioration of general health. The limitations about published studies are discussed, and future perspectives on research on this topic are provided.
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Affiliation(s)
- Aaron M Kipp
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
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19
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Pal D, Kwatra D, Minocha M, Paturi DK, Budda B, Mitra AK. Efflux transporters- and cytochrome P-450-mediated interactions between drugs of abuse and antiretrovirals. Life Sci 2010; 88:959-71. [PMID: 20932495 DOI: 10.1016/j.lfs.2010.09.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/26/2010] [Accepted: 08/28/2010] [Indexed: 01/11/2023]
Abstract
Multidrug regimens and corresponding drug interactions cause many adverse reactions and treatment failures. Drug efflux transporters: P-gp, MRP, BCRP in conjunction with metabolizing enzymes (CYPs) are major factors in such interactions. Most effective combination antiretrovirals (ARV) therapy includes a PI or a NNRTI or two NRTI. Coadministration of such ARV may induce efflux transporters and/or CYP3A4 resulting in sub-therapeutic blood levels and therapeutic failure due to reduced absorption and/or increased metabolism. A similar prognosis is true for ARV-compounds and drugs of abuse combinations. Morphine and nicotine enhance CYP3A4 and MDR1 expression in vitro. A 2.5 fold rise of cortisol metabolite was evident in smokers relative to nonsmokers. Altered functions of efflux transporters and CYPs in response to ARV and drugs of abuse may result in altered drug absorption and metabolism. Appropriate in vitro models can be employed to predict such interactions. Influence of genetic polymorphism, SNP and inter-individual variation in drug response has been discussed. Complexity underlying the relationship between efflux transporters and CYP makes it difficult to predict the outcome of HAART as such, particularly when HIV patients taking drugs of abuse do not adhere to HAART regimens. HIV(+) pregnant women on HAART medications, indulging in drugs of abuse, may develop higher viral load due to such interactions and lead to increase in mother to child transmission of HIV. A multidisciplinary approach with clear understanding of mechanism of interactions may allow proper selection of regimens so that desired therapeutic outcome of HAART can be reached without any side effects.
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Affiliation(s)
- Dhananjay Pal
- Division of Pharmaceutical Sciences, University of Missouri, Kansas City, MO 64108-2718, United States
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20
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Gruber VA, McCance-Katz EF. Methadone, buprenorphine, and street drug interactions with antiretroviral medications. Curr HIV/AIDS Rep 2010; 7:152-60. [PMID: 20532839 PMCID: PMC2892618 DOI: 10.1007/s11904-010-0048-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While street drugs appear unlikely to alter the metabolism of antiretroviral (ARV) medications, several ARVs may induce or inhibit metabolism of various street drugs. However, research on these interactions is limited. Case reports have documented life-threatening overdoses of ecstasy and gamma-hydroxybutyrate after starting ritonavir, an ARV that inhibits several metabolic enzymes. For opioid addiction, methadone or buprenorphine are the treatments of choice. Because a number of ARVs decrease or increase methadone levels, patients should be monitored for methadone withdrawal or toxicity when they start or stop ARVs. Most ARVs do not cause buprenorphine withdrawal or toxicity, even if they alter buprenorphine levels, with rare exceptions to date including atazanavir/ritonavir associated with significant increases in buprenorphine and adverse events related to sedation and mental status changes in some cases. There are newer medications yet to be studied with methadone or buprenorphine. Further, there are many frequently used medications in treatment of complications of HIV disease that have not been studied. There is need for continuing research to define these drug interactions and their clinical significance.
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Affiliation(s)
- Valerie A. Gruber
- San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 93/95, San Francisco, CA 94110 USA
| | - Elinore F. McCance-Katz
- San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 93/95, San Francisco, CA 94110 USA
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21
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Benton T, Blume J, Dubé B. Treatment considerations for psychiatric syndromes associated with HIV infection. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Psychiatric syndromes associated with HIV disease were recognized early in the AIDS epidemic. Public education, new technologies and antiretroviral therapies have resulted in earlier recognition and therapautic interventions of HIV infection, improving the physical health for individuals living with HIV. While HIV-associated psychiatric symptoms have been recognized for more than 20 years, our understanding of the mechanisms underlying psychiatric symptoms among HIV-infected individuals and treatments for these symptoms have not kept pace with advances in HIV therapies. In this article, we discuss current knowledge of the psychiatric symptoms occurring with HIV disease, specifically mood, anxiety and psychotic disorders, evidence-based treatments and treatment considerations, new strategies for the treatments of psychiatric symptoms in HIV disease are also discussed.
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Affiliation(s)
- Tami Benton
- Child & Adolescent Psychiatry, The Children’s Hospital of Philadelphia Behavioral Health Center, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA
| | - Joshua Blume
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
| | - Benoit Dubé
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
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Abstract
Drug use and HIV/AIDS remain serious public health issues in the US. The intersection of the twin epidemics of HIV and drug/alcohol use, results in difficult medical management issues for the healthcare providers who work in the HIV prevention and treatment fields. Access to care and treatment, medication adherence to multiple therapeutic regimens and concomitant drug-drug interactions of prescribed treatments are difficult barriers for drug users to overcome without directed interventions. Injection drug users are frequently disenfranchised from medical care and suffer stigma and discrimination creating additional barriers to care and treatment for their substance use disorders as well as HIV infection. Controlling the transmission of HIV will require access to care and treatment of individuals who abuse illicit drugs and alcohol. Improving health outcomes (e.g. access to and adherence to antiretroviral therapy) among HIV-infected substance users will also require access to evidenced-based pharmacological therapies for the treatment of drug abuse and dependence. The current review presents an overview of issues regarding the use of medication-assisted treatments for substance abuse and dependence among HIV-infected individuals, providing medical management paradigms for their care and treatment.
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Acide gamma-hydroxy-butyrique (GHB) : plus qu’un agent de soumission chimique, une véritable source d’addiction. Presse Med 2009; 38:1526-38. [DOI: 10.1016/j.lpm.2009.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/14/2009] [Accepted: 05/18/2009] [Indexed: 11/18/2022] Open
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Brogan K, Lux J. Management of common psychiatric conditions in the HIV-positive population. Curr HIV/AIDS Rep 2009; 6:108-15. [PMID: 19358782 DOI: 10.1007/s11904-009-0016-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Presentation and management of psychiatric illness in HIV-infected patients can pose a challenge for clinicians. Psychiatric illness can exist premorbidly or result from the progression and treatment of HIV infection, influencing the course of the illness both through behavior and putative biological factors. Mood disorders, anxiety, psychosis, delirium, dementia, and substance abuse disorders all factor heavily into the care of HIV-infected patients. Management, however, continues to draw on small and skewed datasets, and remains largely an extrapolation from seronegative patient experience. The following is a discussion of treatment considerations derived from recent literature, as well as a consideration of judgments that clinicians may make in the absence of available data. The use of antidepressants, stimulants, mood stabilizers, and antipsychotics is discussed, as are precautions that must be taken with the HIV population when using these medications, not only because of side effect vulnerability, but because of significant drug-drug interactions.
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Affiliation(s)
- Kelly Brogan
- Bellevue Hospital Center, 462 First Avenue, 17S #21, New York, NY 10016, USA
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25
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26
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Halkitis P, Palamar J, Mukherjee P. Analysis of HIV medication adherence in relation to person and treatment characteristics using hierarchical linear modeling. AIDS Patient Care STDS 2008; 22:323-35. [PMID: 18290734 DOI: 10.1089/apc.2007.0122] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this investigation was to consider person characteristics, treatment level variables, and illicit drug use to help explain the HIV antiviral adherence patterns of a community-based, non-drug-treatment-seeking sample of men who have sex with men (MSM). Adherence data were gathered for 300 MSM eight times over the course of 1 year using electronic monitoring. Treatment and person level characteristics were assessed at baseline assessment using computer-administered surveys, and drug usage was established via a diagnostic inventory. These longitudinal data were analyzed via Hierarchical Linear Modeling. The sample was diverse in terms of age and race/ethnicity. Across the span of the year in which the participants were assessed, adherence rates were relatively stable and high (means: 82% to 90%) at each time point and remained relatively stable across the yearlong investigation. Lower adherence rates were evident among those who were drug users, black identified (in terms of race), older, and by pill burden. Individuals on HIV antiretroviral therapy demonstrated consistent although not optimal adherence rates when assessed during the course of a year. The significance of numerous person level factors such as age, race, and drug use suggest that adherence to treatment may in part be impacted by the circumstances that the individual brings to the treatment behavior, and suggests interventions that delve beyond the behavioral to consider and address life social and intrapersonal circumstances that may interfere with adherence behaviors.
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Affiliation(s)
- Perry Halkitis
- The Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York
| | - Joseph Palamar
- The Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York
| | - Preetika Mukherjee
- The Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York
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27
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Mwenifumbo JC, Sellers EM, Tyndale RF. Nicotine metabolism and CYP2A6 activity in a population of black African descent: impact of gender and light smoking. Drug Alcohol Depend 2007; 89:24-33. [PMID: 17161559 DOI: 10.1016/j.drugalcdep.2006.11.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 11/10/2006] [Accepted: 11/10/2006] [Indexed: 01/10/2023]
Abstract
Genetic variation in CYP2A6 (the main nicotine metabolizing enzyme) accounts for some, but not all, of the interindividual and interethnic variability in the rates of nicotine metabolism. We conducted a nicotine kinetic study in smokers and nonsmokers of black African descent (N=190), excluding those with common genetic variants in CYP2A6, to investigate the association of demographic variables with CYP2A6 activity (3HC/COT ratio) and nicotine disposition kinetics (estimated nicotine AUC). An additional aim was to examine whether impaired CYP2A6 activity and/or nicotine disposition kinetics were associated with lower cigarette consumption in a population of light smokers (mean<or=10 cigarettes per day). We found that smokers had decreased nicotine metabolism (p<0.05), that women had higher CYP2A6 activity (p<0.01) and that, in non-elderly adults, age did not impact CYP2A6 activity (p=0.65) or nicotine disposition kinetics (p=0.06). Our study also demonstrated that neither current alcohol use nor current marijuana use was associated with altered CYP2A6 activity (p=0.55 and 0.72, respectively) or nicotine disposition kinetics (p=0.38 and 0.91, respectively). Despite the light cigarette consumption of the smokers (N=94), higher CYP2A6 activity was associated with greater cigarette consumption (p<0.005). These findings highlight the need for smoking status and gender to be considered when interpreting studies using nicotine.
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Affiliation(s)
- Jill C Mwenifumbo
- The Centre for Addiction and Mental Health and the Department of Pharmacology, University of Toronto, Canada M5S 1A8
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28
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Ma Q, Okusanya OO, Smith PF, Dicenzo R, Slish JC, Catanzaro LM, Forrest A, Morse GD. Pharmacokinetic drug interactions with non-nucleoside reverse transcriptase inhibitors. Expert Opin Drug Metab Toxicol 2006; 1:473-85. [PMID: 16863456 DOI: 10.1517/17425255.1.3.473] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a diverse group of compounds that inhibit HIV Type 1 reverse transcriptase. Although possessing a common mechanism of action, the approved NNRTIs, delavirdine, efavirenz and nevirapine, differ in structural and pharmacokinetic characteristics. Each of the NNRTIs undergoes biotransformation by the cytochrome P450 (CYP) enzyme system, thus making them prone to clinically significant drug interactions when combined with other antiretrovirals. In addition, they interact with other concurrent medications and complementary/alternative medicines, acting as either inducers or inhibitors of drug-metabolising CYP enzymes. These drug interactions become an important consideration in the clinical use of these agents when designing combination regimens, as recommended by current guidelines. This review provides an updated summary of pharmacokinetic interactions with NNRTIs.
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Affiliation(s)
- Qing Ma
- University at Buffalo, Pharmacotherapy Research Center, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, 317 Hochstetter Hall, Buffalo, NY 14260, USA
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29
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Pal D, Mitra AK. MDR- and CYP3A4-Mediated Drug–Drug Interactions. J Neuroimmune Pharmacol 2006; 1:323-39. [DOI: 10.1007/s11481-006-9034-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 06/16/2006] [Indexed: 11/30/2022]
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30
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Bryant KJ. Expanding research on the role of alcohol consumption and related risks in the prevention and treatment of HIV/AIDS. Subst Use Misuse 2006; 41:1465-507. [PMID: 17002990 DOI: 10.1080/10826080600846250] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article is a review of some of the major epidemiological, behavioral, biological, and integrative prevention research issues and priorities in the area of HIV/AIDS and alcohol consumption. Drinking alcohol increases both the risk for infection with HIV and related illnesses and the morbidity and mortality of patients who progress to AIDS. New and improved measurement procedures have helped in assessment of the complex patterns of alcohol use, identification of intervening explanatory mechanisms for risk behaviors and contexts, and determination of intervention outcomes. Both the direct and indirect effects of alcohol misuse appear to be major contributors to both the risk for infection with HIV and the transmission of HIV/AIDS at the individual and population levels. There is increasing evidence that perhaps no level of alcohol consumption is "safe" for those who are HIV infected and receiving antiretroviral treatment. Interdisciplinary basic behavioral and biomedical research is needed to develop comprehensive culturally appropriate strategies for programs that can be effectively delivered in community contexts in the United States and abroad and that focus on the integration of our understanding of individual behaviors, high-risk group membership, biological mechanisms, and the social and physical environments that place individuals at risk for HIV infection. High-priority topics include improving adherence to antiretroviral medications, prevention of infection in young minority women in the United States, and treatment of HIV+ pregnant women who are alcohol abusers to prevent adverse fetal outcomes, which is an international focus in under-resourced settings in Africa.
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