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Kosana P, Wu K, Tassiopoulos K, Letendre S, Ma Q, Paul R, Ellis R, Erlandson KM, Farhadian SF. Polypharmacy Is Associated With Slow Gait Speed and Recurrent Falls in Older People With HIV. Clin Infect Dis 2024; 78:1608-1616. [PMID: 38147306 PMCID: PMC11175684 DOI: 10.1093/cid/ciad782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Older people with human immunodeficiency virus (HIV, PWH) are prone to using multiple medications due to higher rates of medical comorbidities and the use of antiretroviral therapy (ART). We assessed the prevalence and clinical impact of polypharmacy among PWH. METHODS We leveraged clinical data from the AIDS Clinical Trials Group A5322 study "Long-Term Follow-up of Older HIV-infected Adults: Addressing Issues of Aging, HIV Infection and Inflammation" (HAILO). We included PWH aged ≥40 years with plasma HIV RNA levels <200 copies/µL. We assessed the relationship between polypharmacy (defined as the use of 5 or more prescription medications, excluding ART) and hyperpolypharmacy (defined as the use of 10 or more prescription medications, excluding ART) with slow gait speed (less than 1 meter/second) and falls, including recurrent falls. RESULTS Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. Polypharmacy was more common in women (30%) than men (23%). Participants with polypharmacy had a higher risk of slow gait speed (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.27-2.50) and increased risk of recurrent falls (OR = 2.12; 95% CI = 1.06-4.23). The risk for recurrent falls was further increased in those with hyperpolypharmacy compared with those without polypharmacy (OR = 3.46; 95% CI = 1.32-9.12). CONCLUSIONS In this large, mixed-sex cohort of PWH aged ≥40 years, polypharmacy was associated with slow gait speed and recurrent falls, even after accounting for medical comorbidities, alcohol use, substance use, and other factors. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy in PWH.
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Affiliation(s)
- Priya Kosana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Qing Ma
- School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri–St.Louis, St. Louis, Missouri, USA
| | - Ronald Ellis
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shelli F Farhadian
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024. [PMID: 38753455 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Ni L, Cao Z, Jiang J, Zhang W, Hu W, Zhang Q, Shen C, Chen X, Zheng L. Evaluating Drug Interactions between Ritonavir and Opioid Analgesics: Implications from Physiologically Based Pharmacokinetic Simulation. Pharmaceuticals (Basel) 2024; 17:640. [PMID: 38794210 PMCID: PMC11124264 DOI: 10.3390/ph17050640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Several commonly used opioid analgesics, such as fentanyl, sufentanil, alfentanil, and hydrocodone, are by report primarily metabolized by the CYP3A4 enzyme. The concurrent use of ritonavir, a potent CYP3A4 inhibitor, can lead to significant drug interactions. Using physiologically based pharmacokinetic (PBPK) modeling and simulation, this study examines the effects of different dosing regimens of ritonavir on the pharmacokinetics of these opioids. The findings reveal that co-administration of ritonavir significantly increases the exposure of fentanyl analogs, with over a 10-fold increase in the exposure of alfentanil and sufentanil when given with ritonavir. Conversely, the effect of ritonavir on fentanyl exposure is modest, likely due to additional metabolism pathways. Additionally, the study demonstrates that the steady-state exposure of hydrocodone and its active metabolite hydromorphone can be increased by up to 87% and 95%, respectively, with concurrent use of ritonavir. The extended-release formulation of hydrocodone is particularly affected. These insights from PBPK modeling provide valuable guidance for optimizing opioid dosing and minimizing the risk of toxicity when used in combination with ritonavir-containing prescriptions.
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Affiliation(s)
- Liang Ni
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;
| | - Zhihai Cao
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
- School of Pharmacy, Anhui Medical University, Hefei 230032, China
| | - Jiakang Jiang
- Department of Pharmacy and Biomedical Engineering, Clinical College of Anhui Medical University, Hefei 230031, China;
| | - Wei Zhang
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Wei Hu
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Qian Zhang
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Chaozhuang Shen
- Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu 610041, China;
| | - Xijing Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;
| | - Liang Zheng
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
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Xie X, Gan L, Fu Y, Song Y, Song C, Ren T, Ke C, Long H. Pharmacokinetics and Safety of Ainuovirine/Lamivudine/Tenofovir Combination Tablets in Young and Elderly Patients with Human Immunodeficiency Virus-1 Infection. Infect Dis Ther 2023; 12:2457-2469. [PMID: 37787861 PMCID: PMC10600068 DOI: 10.1007/s40121-023-00877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Ainuovirine/lamivudine/tenofovir is a novel antiretroviral therapy regimen used to treat human immunodeficiency virus-1 (HIV-1) infection. This study aimed to compare the pharmacokinetics of ainuovirine/lamivudine/tenofovir in HIV-1-infected patients aged ≥ 65 (elderly patients) and ≤ 40 years (young patients). METHODS This prospective, open-label, parallel controlled clinical study included 15 young and 15 elderly patients. Blood (1 mL) was collected 30 min before dosing and at 0.5, 1, 1.5, 2, 3, 4, 8, 12, 16, and 24 h after dosing, to measure the plasma concentrations of ainuovirine/lamivudine/tenofovir. Safety was assessed by monitoring the adverse events, physical examinations, and clinical laboratory tests. RESULTS Plasma concentrations of each ainuovirine/lamivudine/tenofovir component reached peak levels 1-4 h after dosing and gradually decreased during the remaining observation period. Compared with the young group, ainuovirine had significantly higher T1/2Ke, AUC0-24, and AUC0-inf (all P < 0.05) in the elderly group, whereas Ke (P = 0.002) was significantly lower. However, the Cmax and Tmax of ainuovirine did not differ significantly. Lamivudine and tenofovir also had a significantly higher Cmax (p = 0.004 and p = 0.008, respectively) and AUC0-inf (P = 0.014 and P = 0.006, respectively) in the elderly group, whereas there was no significant difference in Tmax, Ke, and T1/2Ke. Ainuovirine/lamivudine/tenofovir was well tolerated in both the young and elderly groups. CONCLUSION This study suggests that the ainuovirine/lamivudine/tenofovir regimen might be an effective and safe treatment regimen for HIV-1-infected patients aged ≥ 65 years and ≤ 40 years. Further studies are needed to confirm these results and develop optimal dosing regimens for elderly HIV-1-infected patients.
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Affiliation(s)
- Xiaoxin Xie
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Lin Gan
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Yanhua Fu
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Yebing Song
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Chunli Song
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Tingting Ren
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China
| | - Chan Ke
- Yujing Technology Shanghai Co., Ltd, Shanghai, 200120, China
| | - Hai Long
- Department of Infectious Disease, Guiyang Public Health Clinical Center, Guiyang, 550004, China.
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Thai LW, Hill L, Balcombe S, Karim A, Young Karris M. The Impact of Number of Medications on Falls in Aging Persons with Human Immunodeficiency Virus. Life (Basel) 2023; 13:1848. [PMID: 37763252 PMCID: PMC10533185 DOI: 10.3390/life13091848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to evaluate the impact of polypharmacy on the risk of having a fall in older persons with HIV (PWH). PWH at least 50 years of age who were seen at our institution from September 2012 to August 2017 were included. Unique participants were selected for either a case or control cohort depending on the presence of a documented fall during the study time period. Demographics, HIV-related measures, VACS score, number of medications, as well as the impact of taking benzodiazepines and opioids were compared between the two cohorts. Fall was documented for 637 patients compared to 1534 without a fall during the same time period. Multivariable logistic regression revealed that the total number of medications, having a higher VACS score, taking an opioid, being female sex assigned at birth, and having a lower nadir CD4 count were significantly associated with higher odds of having a fall. In this cohort of older PWH, taking a higher number of non-ARV medications significantly increased the odds of having a fall. In addition, taking an opioid resulted in the highest odds of having a fall. These results suggest the importance of deprescribing and addressing opioid use in reducing the risk of having a fall in older PWH.
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Affiliation(s)
- Leanne W. Thai
- Department of Pharmacy, Scripps Mercy Hospital, San Diego, CA 92103, USA
| | - Lucas Hill
- Department of Pharmacy, University of California San Diego, San Diego, CA 92103, USA
| | - Shannon Balcombe
- Department of Pharmacy, University of California San Diego, San Diego, CA 92103, USA
| | - Afsana Karim
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
| | - Maile Young Karris
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
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Contreras-Macías E, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Influence of polypharmacy in the simultaneous presence of high pharmacotherapeutic complexity, drug interactions and non-adherence to medication in patients with HIV infection. Project 3-HIT. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:342-347. [PMID: 36175284 DOI: 10.1016/j.eimce.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The high pharmacotherapeutic complexity, drug interactions and lack of adherence to concomitant medication are circumstances with negative consequences in the clinical evolution of patients with HIV infection. The 3-HIT phenomenon refers to the simultaneous occurrence of these situations. The objective of the study is to determine the prevalence of the phenomenon 3-HIT in the polymedicated HIV population as well as to determine factors related to its occurrence. METHODS Observational, retrospective and single-center study that included all elderly patients on active antiretroviral treatment in pharmacotherapeutic follow-up between January and March 2020. A logistic regression model was carried out to evaluate the factors associated with the occurrence of the 3-HIT concept with the variables significantly associated with this phenomenon and those considered clinically relevant. RESULTS 428 patients were included, registering a prevalence of polypharmacy in 25.9% of the study sample. The 3-HIT phenomenon was detected in 6.3% of the patients. For each concomitant drug prescribed the risk of developing the phenomenon 3-HIT increases 1.5 times. CONCLUSION Prevalence of the phenomenon 3-HIT is high in HIV patients with polymedication. A change in the pharmaceutical care model to a multidimensional setting is essential, together with pharmacotherapeutic optimization strategies to improve patient health outcomes.
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de Oliveira Costa J, Lau S, Medland N, Gibbons S, Schaffer AL, Pearson S. Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia. Br J Clin Pharmacol 2023; 89:1541-1553. [PMID: 36434744 PMCID: PMC10953433 DOI: 10.1111/bcp.15614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS We quantified concomitant medicine use and occurrence of potential drug-drug interactions in people living with HIV in Australia who are treated with antiretroviral therapy (ART). METHODS In this cohort study using dispensing claims of a 10% random sample of Australians, we identified 2230 people dispensed ART between January 2018 and December 2019 (mean age 49.0 years, standard deviation 12.0 years, 88% male). We examined concomitant medicine use by identifying nontopical medicines dispensed within 90-days of any antiretroviral medicine dispensing during a 12-month follow-up period. For every antiretroviral and nonantiretroviral pair, we identified and classified possible drug-drug interactions using the University of Liverpool HIV drug interactions database. RESULTS A total of 1728 (78%) people were dispensed at least 1 and 633 (28%) 5 or more unique medicines in addition to ART in a 12-month period; systemic anti-infectives and medicines acting on the nervous system were the most common (68% and 56%, respectively). Among comedicated people, 1637 (95%) had at least 1 medicine combination classified as weak interactions, 558 (32%) interactions requiring close monitoring/dose adjustment and 94 (5%) that should not be coadministered. Contraindication or interactions requiring close monitoring/dose adjustment were more common among people receiving protease inhibitors (50-73% across different antiretrovirals), non-nucleoside reverse transcriptase inhibitors (35-64%), people using single-tablet combinations containing elvitegravir (30-46%) and those using tenofovir disoproxil (26-30%). CONCLUSION Concomitant medicine use is widespread among people living with HIV in Australia. Despite a relatively low prevalence of contraindicated medicines, almost a third received medicines that require close monitoring or dose adjustment.
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Affiliation(s)
- Juliana de Oliveira Costa
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
| | - Stella Lau
- Postgraduate Program in Health Data Science, Centre for Big Data Research in Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
| | | | - Sara Gibbons
- Department of PharmacologyUniversity of LiverpoolLiverpoolUK
| | - Andrea L. Schaffer
- Medicines Intelligence Research ProgramSchool of Population Health – Faculty of Medicine and Health/UNSW SydneySydneyAustralia
| | - Sallie‐Anne Pearson
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
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Prevalence of Potentially Clinically Significant Drug-Drug Interactions With Antiretrovirals Against HIV Over Three Decades: A Systematic Review of the Literature. J Acquir Immune Defic Syndr 2023; 92:97-105. [PMID: 36625857 DOI: 10.1097/qai.0000000000003122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Contemporary first-line antiretrovirals have considerably reduced liability for clinically significant drug-drug interactions (DDI). This systematic review evaluates the prevalence of DDI among people receiving antiretrovirals across 3 decades. METHODS We searched 3 databases for studies reporting the prevalence of clinically significant DDIs in patients receiving antiretrovirals published between January 1987 and July 2022. Clinically significant DDIs were graded by severity. All data extractions were undertaken by 2 independent reviewers, adjudicated by a third. RESULTS Of 21,665 records returned, 13,474 were duplicates. After screening the remaining 13,596 abstracts against inclusion criteria, 122 articles were included for full-text analysis, from which a final list of 34 articles were included for data synthesis. The proportion of patients experiencing a clinically significant DDI did not change over time (P = 0.072). The most frequently reported classes of antiretrovirals involved in DDIs were protease inhibitors and non-nucleoside reverse transcriptase inhibitors; of note, integrase use in the most recent studies was highly variable and ranged between 0% and 89%. CONCLUSIONS The absolute risk of DDIs has not decreased over the period covered. This is likely related to continued use of older regimens and an ageing cohort of patients. A greater reduction in DDI prevalence can be anticipated with broader uptake of regimens containing unboosted integrase inhibitors or non-nucleoside reverse transcriptase inhibitors.
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Gordon KS, Crothers K, Butt AA, Edelman EJ, Gibert C, Pisani MM, Rodriguez-Barradas M, Wyatt C, Justice AC, Akgün KM. Polypharmacy and medical intensive care unit (MICU) admission and 10-year all-cause mortality risk among hospitalized patients with and without HIV. PLoS One 2022; 17:e0276769. [PMID: 36302039 PMCID: PMC9612570 DOI: 10.1371/journal.pone.0276769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Medical intensive care unit (MICU) admissions have been declining in people with HIV infection (PWH), but frequency of outpatient polypharmacy (prescription of ≥5 chronic medications) has increased. Among those hospitalized, we examined whether outpatient polypharmacy is associated with subsequent 1-year MICU admission or 10-year all-cause mortality, and if the association varies by HIV status. Design Retrospective cohort study. Methods Using a national electronic health record cohort of Veterans in care, we ascertained outpatient polypharmacy during fiscal year (FY) 2009 and followed patients for 1-year MICU admission and 10-year mortality. We assessed associations of any polypharmacy (yes/no and categorized ≤4, 5–7, 8–9, and ≥10 medications) with 1-year MICU admission and 10-year mortality using logistic and Cox regressions, respectively, adjusted for demographics, HIV status, substance use, and severity of illness. Results Among 9898 patients (1811 PWH) hospitalized in FY2010, prior outpatient polypharmacy was common (51%). Within 1 year, 1532 (15%) had a MICU admission and within 10 years, 4585 (46%) died. Polypharmacy was associated with increased odds of 1-year MICU admission, in both unadjusted (odds ratio (OR) 1.36 95% CI: (1.22, 1.52)) and adjusted models, aOR (95% CI) = 1.28 (1.14, 1.43) and with 10-year mortality in unadjusted, hazard ratio (HR) (95% CI) = 1.40 (1.32, 1.48), and adjusted models, HR (95% CI) = 1.26 (1.19, 1.34). Increasing levels of polypharmacy demonstrated a dose-response with both outcomes and by HIV status, with a stronger association among PWH. Conclusions Among hospitalized patients, prior outpatient polypharmacy was associated with 1-year MICU admission and 10-year all-cause mortality after adjusting for severity of illness in PWH and PWoH.
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Affiliation(s)
- Kirsha S. Gordon
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Medicine, New Haven, CT, United States of America
- * E-mail: (KSG); , (KMA)
| | - Kristina Crothers
- VA Puget Sound Health Care System, Seattle, WA, United States of America
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, WA, United States of America
| | - Adeel A. Butt
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - E. Jennifer Edelman
- Yale School of Medicine, New Haven, CT, United States of America
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America
| | - Cynthia Gibert
- George Washington University School of Medicine, Washington, DC, United States of America
- Washington DC VA Medical Center, Washington, DC, United States of America
| | | | - Maria Rodriguez-Barradas
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States of America
| | - Christina Wyatt
- Duke University School of Medicine, Durham, NC, United States of America
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Medicine, New Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
| | - Kathleen M. Akgün
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Medicine, New Haven, CT, United States of America
- * E-mail: (KSG); , (KMA)
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:258-261. [PMID: 35248518 DOI: 10.1016/j.eimce.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropiate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropiate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
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Evolving patterns of antiretroviral drug interactions in people living with HIV in British Columbia, Canada. AIDS 2022; 36:1105-1115. [PMID: 35285822 DOI: 10.1097/qad.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the annual prevalence of antiretroviral/non-antiretroviral drug interactions (DIs) in relation to antiretroviral therapy (ART) prescribing patterns, and to describe DI-related ART changes. DESIGN/METHODS This cohort study included ART-treated adults in British Columbia, Canada between 01-Jan-2010 and 31-Dec-2016. Medication dispensing records were abstracted from a population-based, linked administrative-health dataset and used to identify antiretroviral-comedication DIs ("caution"/"avoid" DIs in HIV-focused DI-checkers). We identified temporal trends in annual DI prevalence and quantified the association between taking higher DI-risk ART and receiving non-recommended antiretroviral-comedication combinations using Poisson regression models, modified for binary outcomes and correlated data. Clinician-reported, DI-related ART changes and associated adverse events were abstracted from an HIV drug treatment registry and summarized descriptively. RESULTS Among 8571 ART-treated adults who received non-antiretroviral comedications, prevalence of having any DI or receiving non-recommended drug combination(s) significantly declined from 85% to 71% and 5.6% to 3.2%, respectively, between 2010 and 2016 (p < 0.001). This paralleled a shift from higher DI-risk ART (e.g. ritonavir/cobicistat-boosted protease inhibitors) to lower DI-risk ART (e.g. unboosted integrase inhibitors). Risk of receiving a non-recommended antiretroviral-comedication combination was greater for persons taking higher versus lower DI-risk ART (aRR 3.12, 95%CI 2.24-4.35). Boosted antiretroviral-inhaled corticosteroid DIs accounted for the most commonly dispensed, non-recommended drug combinations, and the most commonly reported DI-related adverse events (adrenal insufficiency). CONCLUSION The prevalence of antiretroviral-comedication DIs is declining as ART shifts towards antiretrovirals with lower DI potential, but non-recommended drug combinations remain a concern. Healthcare providers should screen for DIs whenever drugs are prescribed or dispensed.
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Influencia de la polifarmacia en la presencia simultánea de alta complejidad farmacoterapéutica, interacciones medicamentosas y no adherencia a la medicación en pacientes con infección por VIH. Proyecto 3-HIT. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Mechanisms of immune aging in HIV. Clin Sci (Lond) 2022; 136:61-80. [PMID: 34985109 DOI: 10.1042/cs20210344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022]
Abstract
Massive CD4+ T-cell depletion as well as sustained immune activation and inflammation are hallmarks of Human Immunodeficiency Virus (HIV)-1 infection. In recent years, an emerging concept draws an intriguing parallel between HIV-1 infection and aging. Indeed, many of the alterations that affect innate and adaptive immune subsets in HIV-infected individuals are reminiscent of the process of immune aging, characteristic of old age. These changes, of which the presumed cause is the systemic immune activation established in patients, likely participate in the immuno-incompetence described with HIV progression. With the success of antiretroviral therapy (ART), HIV-seropositive patients can now live for many years despite chronic viral infection. However, acquired immunodeficiency syndrome (AIDS)-related opportunistic infections have given way to chronic diseases as the leading cause of death since HIV infection. Therefore, the comparison between HIV-1 infected patients and uninfected elderly individuals goes beyond the sole onset of immunosenescence and extends to the deterioration of several physiological functions related to inflammation and systemic aging. In light of this observation, it is interesting to understand the precise link between immune activation and aging in HIV-1 infection to figure out how to best care for people living with HIV (PLWH).
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Kunimoto Y, Matamura R, Ikeda H, Fujii S, Kimyo T, Kitagawa M, Nakata H, Kobune M, Miyamoto A, Fukudo M. Potential drug-drug interactions in the era of integrase strand transfer inhibitors: a cross-sectional single-center study in Japan. J Pharm Health Care Sci 2021; 7:43. [PMID: 34847955 PMCID: PMC8638141 DOI: 10.1186/s40780-021-00226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Potential drug-drug interactions (PDDIs) commonly occur because of aging and comorbidities in people living with human immunodeficiency virus (HIV; PLWH). Protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been reported to cause PDDIs in these patients. However, there are few reports of PDDIs in the era of treatment using integrase strand transfer inhibitors. Therefore, we investigated PDDIs in Japanese PLWH receiving antiretroviral drugs (ARVs). METHODS This was a cross-sectional observational study conducted in Japanese outpatients. All eligible patients who had received ARV therapy for at least 48 weeks were enrolled. The primary endpoint was the incidence of PDDIs detected using the Lexicomp® interface. RESULTS Of the 71 eligible patients, 51 (71.8%) were prescribed concomitant non-ARV medications. In 21 patients (29.6%), PDDIs with the potential to reduce the effects of ARVs occurred, although the HIV load was suppressed in all cases. Polypharmacy (the use of ≥5 non-ARVs) was observed in 25 patients (35.2%). There was a significantly higher median number of non-ARV medications in the PDDI group than in the non-PDDI group (6 vs. 3, P < 0.001). Furthermore, the proportion of patients on polypharmacy was significantly higher in those with PDDIs than in those without PDDIs (81.0% vs. 26.7%, P < 0.001). CONCLUSIONS The incidence of PDDIs is relatively high in Japanese PLWH, even in the era of treatment using integrase strand transfer inhibitors. Therefore, it is important for patients and health care providers to be constantly aware of PDDIs associated with ARV treatment.
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Affiliation(s)
- Yusuke Kunimoto
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Ryosuke Matamura
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tomoko Kimyo
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Manabu Kitagawa
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiromasa Nakata
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayoshi Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsushi Miyamoto
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Sirtuins as Interesting Players in the Course of HIV Infection and Comorbidities. Cells 2021; 10:cells10102739. [PMID: 34685718 PMCID: PMC8534645 DOI: 10.3390/cells10102739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
The sirtuins (SIRTs) are a family of enzymes from the group of NAD+-dependent deacetylases. Through the reaction of splitting the acetyl group of various transcription factors and histones they regulate many processes in the organism. The activity of sirtuins is linked to metabolic control, oxidative stress, inflammation and apoptosis, and they also affect the course of viral infections. For this reason, they may participate in the pathogenesis and development of many diseases, but little is known about their role in the course of human immunodeficiency virus (HIV) infection, which is the subject of this review. In the course of HIV infection, comorbidities such as: neurodegenerative disorders, obesity, insulin resistance and diabetes, lipid disorders and cardiovascular diseases, renal and bone diseases developed more frequently and faster compared to the general population. The role of sirtuins in the development of accompanying diseases in the course of HIV infection may also be interesting. There is still a lack of detailed information on this subject. The role of sirtuins, especially SIRT1, SIRT3, SIRT6, are indicated to be of great importance in the course of HIV infection and the development of the abovementioned comorbidities.
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Knox C, Leak Date H, Lim SS, Shaw M, Flynn B, Kendall L, Vera J. Facilitating primary care non-antiretroviral drug prescribing in people living with HIV: The 'THINK ARV' initiative. Int J STD AIDS 2021; 33:88-93. [PMID: 34632879 DOI: 10.1177/09564624211047380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Older people living with HIV (PLWH) have higher rates of multimorbidity, polypharmacy and an associated increased risk of potential drug-drug interactions (DDIs). We describe the development, implementation and evaluation of an intervention to increase community prescribers' access to specialist prescribing advice. METHODS Phase One: a survey evaluating General Practitioners' (GPs') knowledge of, and confidence detecting DDIs affecting PLWH, was circulated to eight General Practices in one UK city. Phase Two: co-production was used to develop the THINK ARV intervention for prescribers in city-wide General Practices: a dedicated mobile phone and e-mail advice service staffed by HIV specialist pharmacists. Queries were audited for 6 months pre- and post-intervention. A user-satisfaction survey was emailed to enquirers. RESULTS Phase One: 42 GPs responded, of whom 62% requested further support identifying DDIs among PLWH. Phase Two: the number of queries received increased from 25 (6 months before 'THINK ARV' launch) to 63 in the following 6 months (152% increase). 94% of the queries were specifically about DDIs. CONCLUSIONS Increasing community prescribers' access to specialist telephone and e-mail advice resulted in increased awareness and detection of DDIs. Similar interventions could be embedded within different healthcare settings to optimise medicines and avoid potential patient harm.
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Affiliation(s)
- Chloe Knox
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust.,Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex NHS Foundation Trust, Brighton, UK
| | - Heather Leak Date
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | - Su S Lim
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | - Mark Shaw
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust
| | | | | | - Jaime Vera
- 1949Brighton and Sussex University Hospitals with University Hospitals Sussex NHS Foundation Trust.,Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex NHS Foundation Trust, Brighton, UK
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Justice AC, Gordon KS, Romero J, Edelman EJ, Garcia BJ, Jones P, Khoo S, Lo Re V, Rentsch CT, Tate JP, Tseng A, Womack J, Jacobson D. Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e639-e650. [PMID: 34870254 PMCID: PMC8639138 DOI: 10.1016/s2666-7568(21)00206-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Polypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty. Methods In this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index. Findings We collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97·4%) of 47 116 patients were men and the sample was predominantly aged 50–64 years (30 413 [64·6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with five-to-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1·09 in the random sample, 5·49 in the HIV-negative population, and 7·13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2·94 additional KPDIs and comparators had approximately 2·67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1·08 [95% CI 1·07–1·09] reduced to 1·06 [1·05–1·07]) and those without HIV (1·08 [1·07–1·08] reduced to 1·04 [1·03–1·05]). Interpretation For each additional medication, people ageing with HIV have more drug–drug interactions than those without HIV. Adjusting for known non-ART drug–drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes. Funding National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Department of Veterans Affairs Health Services Research & Development, and Office of Research and Development.
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Affiliation(s)
- Amy C Justice
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Kirsha S Gordon
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Jonathon Romero
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - E Jennifer Edelman
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Benjamin J Garcia
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Piet Jones
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Saye Khoo
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Vincent Lo Re
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Christopher T Rentsch
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Janet P Tate
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Alice Tseng
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Julie Womack
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Daniel Jacobson
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
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Kuemmerle A, Sikalengo G, Vanobberghen F, Ndege RC, Foe G, Schlaeppi C, Burri C, Battegay M, Paris DH, Glass TR, Weisser M, Marzolini C. Recognition and management of clinically significant drug-drug interactions between antiretrovirals and co-medications in a cohort of people living with HIV in rural Tanzania: a prospective questionnaire-based study. J Antimicrob Chemother 2021; 76:2681-2689. [PMID: 34337653 DOI: 10.1093/jac/dkab254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The extent to which drug-drug interactions (DDIs) between antiretrovirals (ARVs) and co-medications are recognized and managed has not been thoroughly evaluated in limited-resource settings. OBJECTIVES This prospective questionnaire-based study aimed to determine the prevalence and risk factors for unrecognized/incorrectly managed DDIs in people living with HIV followed-up at the Chronic Diseases Clinic of Ifakara (CDCI) and enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). METHODS We prospectively included ARV-treated adults receiving ≥1 co-medication coming for a follow-up visit at the CDCI between March and July 2017. Using a structured questionnaire, physicians were requested to identify potentially clinically significant DDIs in the prescribed treatment, to provide recommendations for their management and to indicate any hurdles to implement the recommendations. Prescriptions were subsequently screened for DDIs using the Liverpool DDIs database. Identified clinically significant DDIs and their recommended management according to the DDIs database were compared with the information provided in the questionnaires. RESULTS Among 334 participants, the median age was 47 years (IQR = 40-56 years), 69% were female and 82% had ≥1 non-communicable disease (NCD). Overall, 129 participants had ≥1 clinically relevant DDI, which was not recognized and/or incorrectly managed in 56 participants (43%). Of those, 6 (11%) were due to limited monitoring options or medication affordability issues. In the multivariable logistic regression, the presence of ≥1 NCD was associated with an increased risk for unrecognized/incorrect DDI management (OR = 15.8; 95% CI = 1.8-139.6). CONCLUSIONS Recognition/appropriate management of DDIs is suboptimal, highlighting the need for educational programmes, pharmacovigilance activities and increased access to medications and monitoring options. This should become a focus of HIV programmes given the increasing burden of NCDs in sub-Saharan Africa.
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Affiliation(s)
- Andrea Kuemmerle
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Gideon Foe
- Saint Francis Referral Hospital, Ifakara, Tanzania
| | | | - Christian Burri
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland.,Department of Infectious Diseases & Hospital Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Maja Weisser
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Ifakara Health Institute, Ifakara, Tanzania.,Department of Infectious Diseases & Hospital Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Catia Marzolini
- University of Basel, Basel, Switzerland.,Department of Infectious Diseases & Hospital Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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19
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Murray MM, Lin J, Buros Stein A, Wilcox ML, Cottreau J, Postelnick M, Palella FJ. Relationship of polypharmacy to HIV RNA suppression in people aged ≥ 50 years living with HIV. HIV Med 2021; 22:742-749. [PMID: 34077632 DOI: 10.1111/hiv.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) aged ≥ 50 years face unique challenges regarding their medication therapies, especially antiretroviral therapy (ART). Use of ARTs, along with medications for comorbidities, may lead to adverse events, drug-drug interactions (DDIs) and poor adherence. The objective of this study was to identify the number of medications above which PLWH aged ≥ 50 years are less likely to be virally suppressed and to describe other associated patient-specific risk factors. METHODS This was a cross-sectional study of PLWH aged ≥ 50 years, prescribed ART, and seen at least once in the Northwestern Infectious Disease Center between 1 June 2013 and 31 May 2015. Variables concerning medication use and comorbidities were collected. The primary outcome was the presence of an undetectable plasma HIV RNA level (viral load). RESULTS Among the 621 included patients, there was a higher percentage taking ≤ 15 medications with an undetectable plasma HIV RNA (n = 453; 80.6%) vs. patients taking > 15 medications (n = 40; 67.8%; P = 0.03). Taking > 15 medications [odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.96], pulmonary disease (OR 0.54; 95% CI 0.3-0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22-0.68) decreased the odds of having an undetectable plasma HIV RNA. CONCLUSIONS PLWH taking > 15 medications were less likely to have an undetectable HIV RNA. Further studies are needed to evaluate the impact of overall medication economic burden on clinical outcomes among PLWH ≥ 50 years of age.
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Affiliation(s)
- M M Murray
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Lin
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA
| | - A Buros Stein
- Midwestern University, Office of Research and Sponsored Programs, Glendale, AZ, USA
| | - M L Wilcox
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Cottreau
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - M Postelnick
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - F J Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Tyrberg E, Edén A, Eriksen J, Nilsson S, Treutiger CJ, Thalme A, Mellgren Å, Gisslén M, Andersson LM. Higher plasma drug levels in elderly people living with HIV treated with darunavir. PLoS One 2021; 16:e0246171. [PMID: 33539440 PMCID: PMC7861408 DOI: 10.1371/journal.pone.0246171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/14/2021] [Indexed: 01/01/2023] Open
Abstract
Background The proportion of elderly people living with HIV-1 (PLHIV) is rising. In older patients, comorbidities and concomitant medications are more frequent, increasing the risk of potential drug-drug interactions (PDDIs). Data on the pharmacokinetics of ART in individuals aged ≥ 65 years of age are scarce. We compared plasma drug levels of ART, PDDIs, and side-effects in PLHIV aged ≥ 65 years of age, with controls ≤ 49 years of age. Methods Patients ≥ 65 years of age and controls ≤ 49 years of age, all of whom were on stable treatment with atazanavir (ATV), darunavir (DRV), or efavirenz (EFV) were included cross-sectionally. Plasma drug levels of ART were analyzed, comorbidities, concomitant medication, adherence, and side-effects recorded, and PDDIs analyzed using drug interactions databases. Results Between 2013 and 2015, we included 100 individuals ≥ 65 years of age (study group) and 99 controls (≤ 49 years of age). Steady-state DRV concentrations were significantly higher in the study group than in the control group (p = 0.047). In the ATV group there was a trend towards a significant difference (p = 0.056). No significant differences were found in the EFV arm. The DRV arm had a higher frequency of reported side-effects than the ATV and EFV arms in the study group (36.7% vs. 0% and 23.8% respectively (p = 0.014), with significant differences between DRV vs. ATV, and EFV vs. ATV). Conclusions Higher steady-state plasma levels of DRV and ATV (but not EFV) were found in PLHIV aged ≥ 65 years of age, compared to controls ≤ 49 years of age.
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Affiliation(s)
- Erika Tyrberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arvid Edén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases/Venhälsan, Stockholm South General Hospital, Stockholm, Sweden
| | - Staffan Nilsson
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Carl Johan Treutiger
- Department of Infectious Diseases/Venhälsan, Stockholm South General Hospital, Stockholm, Sweden
| | - Anders Thalme
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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Punekar YS, Parks D, Joshi M, Kaur S, Evitt L, Chounta V, Radford M, Jha D, Ferrante S, Sharma S, Van Wyk J, de Ruiter A. Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence. HIV Med 2021; 22:423-433. [PMID: 33529489 PMCID: PMC8248313 DOI: 10.1111/hiv.13050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 01/21/2023]
Abstract
Objectives Dolutegravir (DTG) is widely recommended within three‐drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two‐drug regimens in clinical trials. This study evaluated the real‐world effectiveness and discontinuations in people living with HIV‐1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). Methods This was a one‐arm meta‐analysis utilizing data from a systematic literature review. Data from real‐world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. Results Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4–1.3] and 0.6% (95% CI: 0.0–1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3–87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0–97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1–16.2) and 7.2% (95% CI: 2.1–14.4) of patients, respectively, at W48. Similar results were observed at W96. Conclusions Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.
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Affiliation(s)
| | - D Parks
- GlaxoSmithKline, Collegeville, PA, USA
| | - M Joshi
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | - S Kaur
- Parexel India, Chandigarh, India
| | - L Evitt
- ViiV Healthcare, Brentford, UK
| | | | | | - D Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | | | - S Sharma
- Parexel India, Chandigarh, India
| | | | - A de Ruiter
- ViiV Healthcare, Brentford, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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22
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30417-1. [PMID: 33451809 DOI: 10.1016/j.eimc.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropriate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropriate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
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23
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Okhai H, Tariq S, Burns F, Gilleece Y, Dhairyawan R, Hill T, Sabin CA. Associations of menopausal age with virological outcomes and engagement in care among women living with HIV in the UK. HIV Res Clin Pract 2020; 21:174-181. [PMID: 33287689 PMCID: PMC8654140 DOI: 10.1080/25787489.2020.1852817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Women ageing with HIV undergo sex-specific changes. There is limited evidence available with regards to how the menopause impacts HIV outcomes. Objective: To investigate whether menopausal age is associated with engagement-in-care (EIC), viral load (VL) suppression and rebound among women living with HIV. Methods: Women were grouped by age (<40, 40–50, >50 years), corresponding to pre-, peri- and post-menopausal stages. EIC, HIV VL suppression (VL < 50 copies/mL) within 12 months of antiretroviral therapy initiation and VL rebound (two consecutive VL > 50 copies/mL) after VL suppression were compared across age groups using logistic/Cox proportional hazards regression. Associations were compared to those seen in heterosexual men. Results: Six thousand four hundred and fifty-five (6455) eligible women (median age 36 [interquartile range: 29–42], 64.4% black African, 19.1% white) contributed 44,226 person-years (PYRS) of follow-up; 29,846, 10,980 and 3,399 PYRS in those aged <40, 40–50 and >50, respectively. Women were engaged-in-care for 79.5% of follow-up time, 3,344 (78.0%) experienced VL suppression and 739 (22.1%) VL rebound. After adjustment, women aged >50 years had lower EIC than those aged <40. Women aged 40–50 were more likely to have VL suppression and were less likely to experience VL rebound than those aged <40 years. Trends in heterosexual men were similar for EIC but with no evidence of a higher VL suppression rate in those aged 40–50 years (pint. 0< .0001) and a stronger protective association between older age and VL rebound (pint. 0< .0001). Conclusion: Our findings warrant further research into the potential impact of the menopause to support women and clinicians through HIV care.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections, University College London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Yvonne Gilleece
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | | - Teresa Hill
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections, University College London, UK
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24
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Yeşilbağ Z, Şengül Eİ, Şenoğlu S, Aydın ÖA, Karaosmanoğlu HK. Co-medications and Drug-Drug Interactions in People Living with HIV in Turkey in the Era of Integrase Inhibitors. Curr HIV Res 2020; 18:415-425. [PMID: 32787762 DOI: 10.2174/1574885515666200812215140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors. METHODS A retrospective observational study was conducted between January 2016-August 2019. Patients' characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. RESULTS Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. CONCLUSION Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.
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Affiliation(s)
- Zuhal Yeşilbağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emine İlay Şengül
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Şenoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Özlem Altuntaş Aydın
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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25
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El Moussaoui M, Lambert I, Maes N, Sauvage AS, Frippiat F, Meuris C, Uurlings F, Lecomte M, Léonard P, Fombellida K, Vaira D, Vercheval C, Moutschen M, Darcis G. Evolution of Drug Interactions With Antiretroviral Medication in People With HIV. Open Forum Infect Dis 2020; 7:ofaa416. [PMID: 33204748 PMCID: PMC7651038 DOI: 10.1093/ofid/ofaa416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/08/2020] [Indexed: 01/02/2023] Open
Abstract
Background Polypharmacy and drug interactions are important issues for HIV-infected individuals. The number and nature of those interactions are continuously evolving with the use of new antiretroviral drugs and the aging of HIV-infected individuals. We aimed to analyze this evolution over time. Methods This retrospective cohort study was conducted in the University Hospital of Liège (Belgium). Treatments of HIV-infected outpatients attending Liège University Hospital were collected and analyzed in 2012 and 2016. The University of Liverpool HIV drug interactions database was used to determine drug interactions. Results We included 1038 patients in 2016, of whom 78% had 1 comedication. Polypharmacy was seen in 20% of the cohort. Four percent of the patients presented red flag interactions, and 38% had orange flag interactions. Nonantiretroviral (non-ARV) therapeutic classes involved in drug interactions were mostly cardiovascular and central nervous system drugs. They were followed by hormone drugs and dietary supplements for orange flag interactions. Two factors significantly contributed to both red and orange flag interactions: the number of non-ARV comedications and protease inhibitor–based ARV regimens. The proportion of patients with red or orange flag interactions remained stable from 2012 to 2016. Conclusions This study highlights the persistence of an alarming number of contraindicated drug interactions and a high prevalence of potential drug interactions over time. Identification, prevention, and management of drug interactions remain a key priority in HIV care.
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Affiliation(s)
| | - Iseult Lambert
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Nathalie Maes
- Department of Biostatistics, Liège University Hospital, Liège, Belgium.,Department of Medico-Economic Information, Liège University Hospital, Liège, Belgium
| | | | - Frédéric Frippiat
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Christelle Meuris
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Françoise Uurlings
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Marianne Lecomte
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Philippe Léonard
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Karine Fombellida
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Dolores Vaira
- AIDS Reference Laboratory, Liège University, Liège, Belgium
| | | | - Michel Moutschen
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium.,AIDS Reference Laboratory, Liège University, Liège, Belgium
| | - Gilles Darcis
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
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26
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Khalilieh S, Yee KL, Sanchez R, Stoch SA, Wenning L, Iwamoto M. Clinical Pharmacokinetics of the Novel HIV-1 Non-Nucleoside Reverse Transcriptase Inhibitor Doravirine: An Assessment of the Effect of Patient Characteristics and Drug-Drug Interactions. Clin Drug Investig 2020; 40:927-946. [PMID: 32816220 PMCID: PMC7511279 DOI: 10.1007/s40261-020-00934-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Doravirine (MK-1439) is a novel non-nucleoside reverse transcriptase inhibitor indicated for the combination treatment of human immunodeficiency virus type-1 (HIV-1) infection. The recommended dose is 100 mg once daily. This review summarizes the pharmacokinetics of doravirine, the influence of intrinsic factors, and its drug-drug interaction (DDI) profile. Following oral administration, doravirine is rapidly absorbed (median time to maximum plasma concentration, 1-4 h) and undergoes cytochrome P450 (CYP)3A-mediated oxidative metabolism. Steady-state geometric means for AUC0-24, C24, and Cmax in individuals with HIV-1 following administration of doravirine 100 mg once daily are 37.8 μM·h, 930 nM, and 2260 nM, respectively. Age, gender, severe renal impairment, and moderate hepatic impairment have no clinically meaningful effect on doravirine pharmacokinetics, and there is limited potential for DDIs. No dose adjustment is necessary when doravirine is co-administered with strong CYP3A inhibitors. However, doravirine is contraindicated with strong CYP3A inducers (e.g., rifampin), and dose adjustment of doravirine is recommended for co-administration with the moderate CYP3A inducer, rifabutin. Included in this review are clinical trial data from phase I pharmacokinetic trials, including DDI trials and trials in participants with renal and hepatic disease but without HIV-1 infection (N = 326), as well as phase I, II, and III safety and efficacy trials in participants living with HIV-1 (N = 991). Based on these data, the pharmacokinetic profile of doravirine supports its use in diverse populations living with HIV-1 and allows co-administration with various antiretroviral agents and treatments for commonly occurring co-morbidities.
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27
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Ruellan AL, Bourneau-Martin D, Joyau C, Secher S, Fialaire P, Hitoto H, Leautez S, Michau C, Vatan R, Billaud E, Briet M, Jolliet P, Raffi F, Allavena C. Assessment of drug-drug interaction in an elderly human immunodeficiency virus population: Comparison of 3 expert databases. Br J Clin Pharmacol 2020; 87:1194-1202. [PMID: 32696528 DOI: 10.1111/bcp.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS Polypharmacy increase the risk of drug-drug interactions (DDIs) in the elderly population living with human immunodeficiency virus (HIV). Several expert databases can be used to evaluate DDIs. The aim of the study was to describe actual DDIs between antiretroviral drugs and comedications in an elderly population and to compare grading of the DDIs in 3 databases. METHODS All treatments of HIV-infected subjects aged 65 years and older were collected in 6 French HIV centres. Summary of Product Characteristic (SPC), French DDI Thesaurus (THES), and Liverpool HIV DDI website (LIV) were used to define each DDI and specific grade. DDIs were classified in yellow flag interaction (undefined grade in SPC and THES or potential weak interaction in LIV), amber flag interaction (to be considered/precaution of use in SPC and THES and potential interaction in LIV) and red flag interaction (not recommended/contraindication in SPC and THES and do not administer/contraindication in LIV). RESULTS Among 239 subjects included, 60 (25.1%) had at least 1 DDI for a total of 126 DDIs: 23/126 red flag DDIs were identified in 17 patients. All these 23 DDIs were identified in LIV. THES and SPC missed 6 and 1 red flag DDIs, respectively. Seven of 23 red flag DDIs were identified in the 3 databases concomitantly. CONCLUSION Polypharmacy is frequent in this elderly HIV population leading to DDI in a quarter of the subjects. The discrepancies between databases can be explained by differences in analysis methods. A consensus between databases would be helpful for clinicians.
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Affiliation(s)
- Anne-Lise Ruellan
- Department of Clinical Pharmacology. Institute of Biology, University Hospital, Nantes, France
| | | | - Caroline Joyau
- Department of Clinical Pharmacology. Institute of Biology, University Hospital, Nantes, France
| | | | - Pascale Fialaire
- Department of Tropical and Infectious Diseases, University Hospital, Angers, France
| | - Hikombo Hitoto
- Department of Tropical and Infectious Diseases, Hospital, Le Mans, France
| | - Sophie Leautez
- Department of Post-Emergency, Departmental Hospital, La Roche sur Yon, France
| | | | - Rémi Vatan
- Department of Polyvalent Medicine, Hospital, Laval, France
| | - Eric Billaud
- COREVIH Pays de la Loire.,Department of Infectious Diseases, and CIC 1413, INSERM, University Hospital, Nantes, France
| | - Marie Briet
- Department of Clinical Pharmacology. Institute of Biology, University Hospital, Angers, France
| | - Pascale Jolliet
- Department of Clinical Pharmacology. Institute of Biology, University Hospital, Nantes, France
| | - François Raffi
- Department of Infectious Diseases, and CIC 1413, INSERM, University Hospital, Nantes, France
| | - Clotilde Allavena
- Department of Infectious Diseases, and CIC 1413, INSERM, University Hospital, Nantes, France
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Lopes S, O'Day K, Meyer K, Van Stiphout J, Punekar Y, Radford M, Haas JS. Comedication prescription patterns and potential for drug-drug interactions with antiretroviral therapy in people living with human immunodeficiency virus type 1 infection in Germany. Pharmacoepidemiol Drug Saf 2020; 29:270-278. [PMID: 31950545 DOI: 10.1002/pds.4928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Various first-line recommended antiretroviral therapy (ART) regimens have different drug-drug interaction (DDI)/contraindication profiles. The aim of this study was to estimate the rate of potential DDIs/contraindications of real-world prescribed non-ART comedication with first-line recommended ART in people living with HIV (PLHIV) in Germany. METHODS A retrospective, cross-sectional cohort design was used to collect non-ART comedication prescription data from a representative sample of a German health insurance claims database. PLHIV who were prescribed ART during 2016 were included in the analysis. Patients were stratified by sex, age, comorbidities, and time on ART. Prescribed comedications were used to estimate potential DDIs/contraindications for each recommended first-line ART per patient based on criteria from www.hiv-druginteractions.org. RESULTS Records from 2680 PLHIV were analyzed. Prescriptions for non-ART comedications were common (mean of seven per patient in the overall population, 10.2 in PLHIV aged 50 years and older). Antiretroviral regimens with the lowest proportion of patients with at least 1 potential DDI/contraindication were unboosted integrase inhibitor, non-tenofovir disoproxil fumarate-based regimens that included raltegravir + emtricitabine/tenofovir alafenamide fumarate (13%), dolutegravir + lamivudine (14%), dolutegravir/abacavir/lamivudine (14%), dolutegravir/emtricitabine/tenofovir alafenamide fumarate (15%), and bictegravir/emtricitabine/tenofovir alafenamide fumarate (19%). Boosted regimens and efavirenz-based regimens presented the highest potential for DDIs/contraindications. CONCLUSIONS Comedication with potential DDIs/contraindications with ART is frequently prescribed among PLHIV in Germany. Potential risks for DDIs/contraindications vary by ART, with the lowest potential seen in unboosted integrase strand transfer inhibitor-based regimens, including raltegravir + emtricitabine/tenofovir alafenamide fumarate, followed by three dolutegravir-based regimens.
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Affiliation(s)
- Sara Lopes
- Global Health Outcomes, ViiV Healthcare, Brentford, UK.,Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Ken O'Day
- Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Kellie Meyer
- Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Joris Van Stiphout
- Global HEOR and Market Access, Xcenda Switzerland GmbH, Bern, Switzerland
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Blanco JR, Morillo R, Abril V, Escobar I, Bernal E, Folguera C, Brañas F, Gimeno M, Ibarra O, Iribarren JA, Lázaro A, Mariño A, Martín MT, Martinez E, Ortega L, Olalla J, Robustillo A, Sanchez-Conde M, Rodriguez MA, de la Torre J, Sanchez-Rubio J, Tuset M. Deprescribing of non-antiretroviral therapy in HIV-infected patients. Eur J Clin Pharmacol 2019; 76:305-318. [PMID: 31865412 DOI: 10.1007/s00228-019-02785-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE In recent decades, the life expectancy of HIV-infected patients has increased considerably, to the extent that the disease can now be considered chronic. In this context of progressive aging, HIV-infected persons have a greater prevalence of comorbid conditions. Consequently, they usually take more non-antiretroviral drugs, and their drug therapy are more complex. This supposes a greater risk of drug interactions, of hospitalization, falls, and death. In the last years, deprescribing has gained attention as a means to rationalize medication use. METHODS Review of the different therapeutic approach that includes optimization of polypharmacy and control and reduction of potentially inappropriate prescription. RESULTS There are several protocols for systematizing the deprescribing process. The most widely used tool is the Medication Regimen Complexity Index, an index validated in HIV-infected persons. Anticholinergic medications are the agents that have been most associated with major adverse effects so, various scales have been employed to measure it. Other tools should be employed to detect and prevent the use of potentially inappropriate drugs. Prioritization of candidates should be based, among others, on drugs that should always be avoided and drugs with no justified indication. CONCLUSIONS The deprescribing process shared by professionals and patients definitively would improve management of treatment in this population. Because polypharmacy in HIV-infected patients show that a considerable percentage of patients could be candidates for deprescribing, we must understand the importance of deprescribing and that HIV-infected persons should be a priority group. This process would be highly feasible and effective in HIV-infected persons.
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Affiliation(s)
- José-Ramón Blanco
- Hospital Universitario San Pedro - CIBIR de Logroño, Logroño, La Rioja, Spain.
| | | | - Vicente Abril
- Hospital General Universitario de Valencia, 46014, València, Valencia, Spain
| | - Ismael Escobar
- Hospital Infanta Leonor del Madrid, Universidad Complutense, 28040, Madrid, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía de Murcia, 30003, Murcia, Spain
| | - Carlos Folguera
- Hospital Puerta de Hierro de Madrid, 28222, Majadahonda, Madrid, Spain
| | - Fátima Brañas
- Hospital Infanta Leonor del Madrid, Universidad Complutense, 28040, Madrid, Spain
| | | | - Olatz Ibarra
- Hospital de Urduliz, Bizkaia, 48610, Urduliz, Biscay, Spain
| | - José-Antonio Iribarren
- Hospital Universitario Donostia, Instituto BioDonostia de San Sebastián, 20014, San Sebastián, Spain
| | | | - Ana Mariño
- Complejo Hospitalario Universitario de Ferrol, 15405, Ferrol, A Coruña, Spain
| | | | | | | | - Julian Olalla
- Hospital Costa del Sol de Marbella, 29603, Marbella, Málaga, Spain
| | | | | | | | | | | | - Montse Tuset
- Hospital Clinic de Barcelona, 08036, Barcelona, Spain
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Safreed-Harmon K, Anderson J, Azzopardi-Muscat N, Behrens GMN, d'Arminio Monforte A, Davidovich U, Del Amo J, Kall M, Noori T, Porter K, Lazarus JV. Reorienting health systems to care for people with HIV beyond viral suppression. Lancet HIV 2019; 6:e869-e877. [PMID: 31776099 DOI: 10.1016/s2352-3018(19)30334-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023]
Abstract
The effectiveness of antiretroviral therapy and its increasing availability globally means that millions of people living with HIV now have a much longer life expectancy. However, people living with HIV have disproportionately high incidence of major comorbidities and reduced health-related quality of life. Health systems must respond to this situation by pioneering care and service delivery models that promote wellness rather than mere survival. In this Series paper, we review evidence about the emerging challenges of the care of people with HIV beyond viral suppression and identify four priority areas for action: integrating HIV services and non-HIV services, reducing HIV-related discrimination in health-care settings, identifying indicators to monitor health systems' progress toward new goals, and catalysing new forms of civil society engagement in the more broadly focused HIV response that is now needed worldwide. Furthermore, in the context of an increasing burden of chronic diseases, we must consider the shift that is underway in the HIV field in relation to burgeoning policy and programmatic efforts to promote healthy ageing.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital National Health Service Foundation Trust, London, UK
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, WHO Collaborating Centre on Health Systems and Policies in Small States, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Georg M N Behrens
- Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany; German Centre for Infection Research, Hannover, Germany, Partner-site Hannover-Braunschweig, Germany
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, L'Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Udi Davidovich
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Del Amo
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain; National Plan against HIV/AIDS/STIs, Ministry of Health, Consumer Affairs and Welfare, Madrid, Spain
| | - Meaghan Kall
- HIV/STI Department, Public Health England, London, UK
| | - Teymur Noori
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Kholoud Porter
- Surveillance and Response Unit University College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Montano M, Bhasin S, D'Aquila RT, Erlandson KM, Evans WJ, Funderburg NT, Justice A, Ndhlovu LC, Ojikutu B, Pahor M, Pahwa S, Ryan AS, Schrack J, Schultz MB, Sebastiani P, Sinclair DA, Tripp J, Walker B, Womack JA, Yung R, Reeves RK. Harvard HIV and Aging Workshop: Perspectives and Priorities from Claude D. Pepper Centers and Centers for AIDS Research. AIDS Res Hum Retroviruses 2019; 35:999-1012. [PMID: 31456412 DOI: 10.1089/aid.2019.0130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
People aging with HIV (PAWH) infection experience greater impairments in physical and cognitive function, in addition to higher rates of peripheral comorbid conditions (e.g., renal failure, diabetes, bone fracture, hypertension, cardiovascular disease, polypharmacy, and multimorbidity). While multifactorial drivers, including HIV infection itself, antiretroviral therapy-related toxicities, disparities in care, and biobehavioral factors, likely contribute, there remains an overarching question as to what are the relevant age-related mechanisms and models that could inform interventions that promote health span and life span in PAWH? This workshop was convened to hear from experts on the biology of aging and HIV researchers studying PAWH to focus on advancing investigations at the interface of HIV and Aging. In this study, we summarize the discussions from the Harvard Center for AIDS Research and Boston Claude D. Pepper cosponsored workshop on HIV and Aging, which took place in October 2018.
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Affiliation(s)
- Monty Montano
- Boston Pepper OAIC, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shalender Bhasin
- Boston Pepper OAIC, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, California
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio
| | - Amy Justice
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lishomwa C Ndhlovu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Bisola Ojikutu
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida
| | - Savita Pahwa
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alice S Ryan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Geriatric Research Education and Clinical Center and Research and Development Service, Baltimore, Maryland
| | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael B Schultz
- Department of Genetics, Paul F. Glenn Labs for the Biology of Aging, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Paola Sebastiani
- Department of Biostatistics, Boston University, Boston, Massachusetts
| | - David A Sinclair
- Department of Genetics, Paul F. Glenn Labs for the Biology of Aging, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Julia Tripp
- Harvard University Center for AIDS Research, Cambridge, Massachusetts
| | - Bruce Walker
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
| | - Julie A Womack
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Nursing, West Haven, Connecticut
| | - Raymond Yung
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - R Keith Reeves
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Livio F, Marzolini C. Prescribing issues in older adults living with HIV: thinking beyond drug-drug interactions with antiretroviral drugs. Ther Adv Drug Saf 2019; 10:2042098619880122. [PMID: 31620274 PMCID: PMC6777047 DOI: 10.1177/2042098619880122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Françoise Livio
- Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, CH-4031 Basel, Switzerland
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Fernández Cañabate S, Ortega Valín L. Polypharmacy among HIV infected people aged 50 years or older. Colomb Med (Cali) 2019; 50:142-152. [PMID: 32284660 PMCID: PMC7141145 DOI: 10.25100/cm.v50i3.4128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Although HAART cannot eradicate HIV, it suppresses viral replication, resulting in a progressive reduction in HIV-related morbidity and mortality. The increase in life expectancy for HIV-infected patients has turned this disease into a chronic disease and, therefore, to the appearance of comorbidities. At the same time there is an increase in the use of concomitant medication, making HIV-infected patient a polymedicated patient. Objective: To determine the degree of polypharmacy and to describe clinically relevant drug interactions, as well as the comorbidities and adherence to HAART in HIV + patients over 50 years. Methods: Observational, transversal study. Patients ≥50 years on HAART ambulatory were included. The variables were collected: aged, sex, VL, CD4, comorbidities, ARV, concomitant medication, herbal products and adherence. Patients who did not sign informed consent were excluded. Results: Were included 154 patients ≥50 years on HAART. The presence of polypharmacy, defined as the use of 5 or more medications including HAART, was 40.3%. 73.4% of the patients had concomitant medication: lipid-lowering agents (33.8%), anxiolytics / sedatives (28.6%), proton-pump inhibitors (26.0%) antihypertensive agents (23.4%). 102 relevant interactions were recorded, finding statistically significant differences in relation to the presence of polypharmacy and pharmacologic drugs classes (p <0.001). Conclusion: The prevalence of polypharmacy among HIV+ patients ≥50 years is high. Comorbidities, interactions and drugs associated were similar to those described in the literature. It is necessary to establish priorities in relation to drug interactions with polypharmacy and a correct approach to the pathologies that may develop.
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Affiliation(s)
| | - Luis Ortega Valín
- Complejo Asistencial Universitario de León, Servicio de Farmacia, León, España
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Gutierrez MDM, Mateo MG, Corbacho N, Vidal F, Domingo P. Drug-drug interactions when treating HIV-related metabolic disorders. Expert Opin Drug Metab Toxicol 2019; 15:787-802. [PMID: 31512529 DOI: 10.1080/17425255.2019.1667334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Drug-drug interactions (DDI) between antiretroviral drugs and drugs for the treatment of metabolic disturbances in people living with human immunodeficiency virus (HIV) (PLWH) have represented a problem of paramount importance in the recent times. The problem has been mainly driven by sharing common metabolizing pathways. This problem has classically been worsened by the frequent use of pharmacokinetic boosters to enhance protease inhibitors and some integrase inhibitors plasma levels. Areas covered: This article focuses on the interactions between antiretroviral drugs and those drugs used to treat metabolic disturbances which frequently appear in PLWH. These include dyslipidemia, diabetes mellitus, hyperuricemia, and finally, drugs for the treatment of overweight and clinical obesity. References from PubMed, Embase, or Web of Science, among others, were reviewed. Expert opinion: The advent of safer drugs, in terms of DDI, in the antiretroviral and the metabolic field,such as non-boosted antiretrovirals and drugs with divergent metabolizing paths. Besides, learning by the caregivers on how to decrease and manage DDI, together with the extensive use of online updated DDI databases, has undoubtedly minimized the problem. The foreseeable increase in the burden of HIV-associated comorbidities and their associated treatments anticipates further complexities in the management of DDI in PLWH.
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Affiliation(s)
- Maria Del Mar Gutierrez
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Mª Gracia Mateo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Noemí Corbacho
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Francesc Vidal
- HIV Infection Unit, Department of Internal Medicine, Hospital Universitari Joan XXIII, Institut de Recerca Rovira i Virgili , Tarragona , Spain
| | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
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Mama Djima M, Ekouevi DK, Gregoire JP, Tchounga B, Coffie PA, Tran VT, Touré FY, Moisan J. Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study. PLoS One 2019; 14:e0221335. [PMID: 31525222 PMCID: PMC6746366 DOI: 10.1371/journal.pone.0221335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire. Methods A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. Results A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. Conclusion Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.
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Affiliation(s)
- Mariam Mama Djima
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Institut Pasteur de Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- * E-mail:
| | - Didier Koumavi Ekouevi
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm U 1219, ISPED, Université Victor Segalen, Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Jean-Pierre Gregoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | | | | | | | | | - Jocelyne Moisan
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
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Abstract
Objective: Compare the efficacy and safety of the 2-drug antiretroviral therapy regimen dolutegravir + lamivudine (DTG + 3TC) with traditional 3-drug regimens in treatment-naive patients with HIV-1. Design: Data from double-blind, randomized controlled trials of at least 48 weeks’ duration in treatment-naive patients with HIV-1 identified by systematic review were evaluated using a Bayesian network meta-analysis methodology. Methods: The primary outcome was virologic suppression at Week 48 for 3-drug regimens versus DTG + 3TC (also analyzed in patient subgroup with baseline viral load >100 000 RNA copies/ml). Secondary outcomes included CD4+ cell count change from baseline and safety (adverse events, serious adverse events, and drug-related adverse events) at Week 48. Results: The network contains 14 unique regimens from 14 randomized controlled trials based on data from 10 043 patients. The proportional difference for viral suppression at 48 weeks for DTG + 3TC versus the other 13 regimens included in the network ranged from −2.7% (−11.0, 5.6%) versus DTG + tenofovir alafenamide/emtricitabine (FTC) to 7.3% (0.6, 13.8%) versus efavirenz + tenofovir disoproxil fumarate/FTC. DTG + 3TC was found to be significantly better than efavirenz + tenofovir disoproxil fumarate/FTC and similar to all other regimens analysed in terms of viral suppression at 48 weeks. With regard to other outcomes (CD4+, adverse event, serious adverse event, drug-related adverse events) at 48 weeks, DTG+3TC was broadly similar to all regimens analysed. Conclusion: This network meta-analysis demonstrates similar efficacy and safety outcomes over 48 weeks with DTG + 3TC compared with traditional 3-drug antiretroviral therapy regimens.
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Resende NHD, Miranda SSD, Ceccato MDGB, Haddad JPA, Reis AMM, Silva DID, Carvalho WDS. Drug therapy problems for patients with tuberculosis and HIV/AIDS at a reference hospital. EINSTEIN-SAO PAULO 2019; 17:eAO4696. [PMID: 31460617 PMCID: PMC6706227 DOI: 10.31744/einstein_journal/2019ao4696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/27/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS. Methods: Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression. Results: We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis. Conclusion: The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.
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Affiliation(s)
| | | | | | | | | | - Dirce Inês da Silva
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, MG, Brasil
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Kiplagat J, Mwangi A, Chasela C, Huschke S. Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya. BMC Public Health 2019; 19:929. [PMID: 31296195 PMCID: PMC6624873 DOI: 10.1186/s12889-019-7283-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/05/2019] [Indexed: 12/27/2022] Open
Abstract
Background While younger adults (15–49 years) form the majority of the population living with HIV, older adults (≥50 years) infected with HIV face multiple challenges related to the aging process and HIV. We explored the experiences of older persons infected with HIV at the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya to understand the challenges faced when seeking HIV care services. Methods Between November 2016 and April 2017, a total of 57 adults aged 50 years and above were recruited from two AMPATH facilities – one rural and one urban facility. A total of 25 in-depth interviews and four focus group discussions were conducted, audio-recorded, transcribed and thematic analysis performed. Results Study participants raised unique challenges with seeking HIV care that include visits to multiple healthcare providers to manage HIV and comorbidities and as a result impact on their adherence to medication and clinical visits. Challenges with inadequate quality of facilities and poor patient-provider communication were also raised. Participants’ preference for matched gender and older age for care providers that serve older patients were identified. Conclusion Results indicate multiple challenges faced by older adults that need attention in ensuring continuous engagement in HIV care. Targeted HIV care for older adults would, therefore, significantly improve their access to and experience of HIV care. Of key importance is the integration of other chronic diseases into HIV care and employing staff that matches the needs of older adults. Electronic supplementary material The online version of this article (10.1186/s12889-019-7283-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jepchirchir Kiplagat
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya. .,Academic Model Providing Access to Healthcare, Eldoret, Kenya. .,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ann Mwangi
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.,Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Charles Chasela
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, EQUIP, 1006 Lenchen North Avenue, Centurion, Pretoria, South Africa
| | - Susann Huschke
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Abstract
Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.
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Affiliation(s)
- Catia Marzolini
- a Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital of Basel and University of Basel , Basel , Switzerland.,b Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool , UK
| | - Françoise Livio
- c Service of Clinical Pharmacology, Department of Laboratories , University Hospital of Lausanne , Lausanne , Switzerland
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Burden of Exposure to Potential Interactions Between Antiretroviral and Non-Antiretroviral Medications in a Population of HIV-Positive Patients Aged 50 Years or Older. J Acquir Immune Defic Syndr 2019; 78:193-201. [PMID: 29767640 DOI: 10.1097/qai.0000000000001653] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND As HIV-infected patients aged 50 years or older are at increased risk of comorbidities and multidrug treatments, we examined their exposure to the potential drug-drug interactions (PDDIs) of antiretroviral (ARV) and other medications. METHODS This cross-sectional study involved the patients aged 50 years or older receiving ARV and non-ARV medications at our clinic. PDDIs were identified using the University of Liverpool HIV Drug Interaction Checker. Logistic regression models were used to assess risk factors for PDDIs. The American Geriatrics Society Beers Criteria were used to identify potentially inappropriate medications (PIMs). RESULTS A total of 395 (53.9%) of 744 patients showed ≥1 PDDI: 47.4% ≥ 1 amber-PDDI (comedications requiring appropriate management) and 5.6% ≥ 1 red-PDDI (contraindicated comedications). A higher risk of PDDIs was associated with the use of ≥5 medications (P < 0.001), of antiosteoporotics (P < 0.001), calcium channel blockers (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001), hypnotics/sedatives (P = 0.022), and anticoagulants (P = 0.006). A higher risk of red-PDDIs was associated with the use of antacids (P < 0.001), anti-benign prostatic hypertrophy agents (P < 0.001) and antipsychotics (P = 0.023). The use of nucleoside reverse transcriptase inhibitor + nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor + integrase strand transfer inhibitor rather than protease inhibitor-based regimens was associated with a reduced risk of PDDIs (P < 0.001). Overall, 119 (16.0%) patients were receiving PIMs (mainly hypnotics/sedatives) and 49 (41.2%) of them had PDDIs able to increase the blood levels of these medications. CONCLUSIONS Older patients with HIV are highly exposed to PDDIs between ARVs and comedications. The knowledge of their complete medication regimens and the screening for PDDIs and PIMs is therefore crucial to prevent drug-related adverse outcomes in this population.
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Khalilieh SG, Yee KL, Sanchez RI, Fan L, Anderson MS, Sura M, Laethem T, Rasmussen S, van Bortel L, van Lancker G, Iwamoto M. Doravirine and the Potential for CYP3A-Mediated Drug-Drug Interactions. Antimicrob Agents Chemother 2019; 63:e02016-18. [PMID: 30783000 PMCID: PMC6496093 DOI: 10.1128/aac.02016-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/12/2019] [Indexed: 12/30/2022] Open
Abstract
Identifying and understanding potential drug-drug interactions (DDIs) are vital for the treatment of human immunodeficiency virus type 1 (HIV-1) infection. This article discusses DDIs between doravirine, a nonnucleoside reverse transcriptase inhibitor (NNRTI), and cytochrome P450 3A (CYP3A) substrates and drugs that modulate CYP3A activity. Consistent with previously published in vitro data and DDI trials with the CYP3A substrates midazolam and atorvastatin, doravirine did not have any meaningful impact on the pharmacokinetics of the CYP3A substrates ethinyl estradiol and levonorgestrel. Coadministration of doravirine with CYP3A inhibitors (ritonavir or ketoconazole) increased doravirine exposure approximately 3-fold. However, these increases were not considered clinically meaningful. Conversely, previously published trials showed that coadministered CYP3A inducers (rifampin and rifabutin) decreased doravirine exposure by 88% and 50%, respectively (K. L. Yee, S. G. Khalilieh, R. I. Sanchez, R. Liu, et al., Clin Drug Investig 37:659-667, 2017 [https://doi.org/10.1007/s40261-017-0513-4]; S. G. Khalilieh, K. L. Yee, R. I. Sanchez, R. Liu, et al., J Clin Pharmacol 58:1044-1052, 2018 [https://doi.org/10.1002/jcph.1103]), while doravirine exposure following prior efavirenz administration led to an initial reduction in doravirine exposure of 62%, but the reduction became less pronounced with time (K. L. Yee, R. I. Sanchez, P. Auger, R. Liu, et al., Antimicrob Agents Chemother 61:e01757-16, 2017 [https://doi.org/10.1128/AAC.01757-16]). Overall, the coadministration of doravirine with CYP3A inhibitors and substrates is, therefore, supported by these data together with efficacy and safety data from clinical trials, while coadministration with strong CYP3A inducers, such as rifampin, cannot be recommended. Concomitant dosing with rifabutin (a CYP3A inducer less potent than rifampin) is acceptable if doravirine dosing is adjusted from once to twice daily; however, the effect of other moderate inducers on doravirine pharmacokinetics is unknown.
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Affiliation(s)
| | - Ka Lai Yee
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Li Fan
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Monali Sura
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | - Luc van Bortel
- Department of Pharmacology, Ghent University, Ghent, Belgium
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Sangiovanni RJ, Jakeman B, Nasiri M, Ruth L, Mahatme S, Patel N. Short Communication: Relationship Between Contraindicated Drug-Drug Interactions and Subsequent Hospitalizations Among Patients Living with HIV Initiating Combination Antiretroviral Therapy. AIDS Res Hum Retroviruses 2019; 35:430-433. [PMID: 30612438 DOI: 10.1089/aid.2018.0205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Persons living with HIV (PLWH) are at an increased risk of contraindicated drug-drug interactions (XDDIs), which may result in deleterious outcomes. Study objectives were to (1) compare the frequency of hospitalizations between patients with and without XDDIs and (2) determine if XDDIs are independently associated with hospitalizations in PLWH. A retrospective cohort study was performed among PLWH receiving care at the Upstate New York Veterans' Healthcare Administration or University of New Mexico Truman Health Services from 2000 to 2013. Hospitalization was defined as an admission to an inpatient hospital facility for ≥24 h. Of the 1329 patients evaluated, 149 (11.2%) patients were hospitalized within 1 year of antiretroviral therapy initiation. A significantly higher proportion of patients with XDDIs were hospitalized compared with those who did not have XDDIs (20.3% vs. 10.2%, risk ratio: 1.98, 95% confidence interval [CI]: 1.35-2.91, p = .001). In the multivariate Cox proportional hazards regression analyses, XDDIs were independently associated with hospitalizations (hazard ratio [HR]: 1.58; 95% CI: 1.00-2.48; p = .05), after adjustment for CD4 < 242 cells/mm3 (HR: 2.38; 95% CI: 1.72-3.33; p < .001), protease inhibitor (PI)-based regimen (HR: 1.35; 95% CI: 0.97-1.89; p = .08), recreational drug use (HR: 2.58, 95% CI: 1.85-3.58, p < .001), and non-HIV medications ≥10 (HR: 1.62; 95% CI: 0.97-2.69; p = .07). In this study an increased risk of hospitalization was observed among PLWH with XDDIs compared with those without XDDIs. This relationship persisted after adjustment for CD4 count, use of a PI-based regimen, recreational drug use, and number of non-HIV medications.
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Affiliation(s)
- Ryan J. Sangiovanni
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, South Carolina
- Departments of Pharmacy and Research, Stratton Veterans' Affairs Medical Center, Albany, New York
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Mona Nasiri
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Lindsey Ruth
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Sheran Mahatme
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nimish Patel
- Departments of Pharmacy and Research, Stratton Veterans' Affairs Medical Center, Albany, New York
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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Demessine L, Peyro-Saint-Paul L, Gardner EM, Ghosn J, Parienti JJ. Risk and Cost Associated With Drug-Drug Interactions Among Aging HIV Patients Receiving Combined Antiretroviral Therapy in France. Open Forum Infect Dis 2019; 6:ofz051. [PMID: 30949521 PMCID: PMC6440683 DOI: 10.1093/ofid/ofz051] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to describe the frequency, risk factors, and costs attributable to drug–drug interactions (DDIs) among an aging French HIV population. Methods We conducted a retrospective cohort study using French nationwide health care e-records: the SNIIRAM database. People living with HIV (PLWH) aged >65 years and receiving combined antiretroviral treatment (cART) during 2016 were included. A DDI was defined as “These drugs should not be co-administered,” represented by a red symbol on the University of Liverpool website. Attributable DDIs’ cost was defined as the difference between individuals with and without DDIs regarding all reimbursed health care acts. Results Overall, 9076 PLWH met the study criteria. Their baseline characteristics were: mean age, 71.3 ± 4.9 years; 25% female; median HIV duration (interquartile range [IQR]), 16.2 (9.5–20.3) years; median comorbidities (IQR), 2 (1–3). During 2016, they received a median (IQR) of 14 (9–21) comedications (non-cART), and 1529 individuals had at least 1 DDI (16.8%; 95% confidence interval [CI], 16.1–17.6). In multivariate analysis, raltegravir or dolutegravir plus 2 nucleoside reverse-transcriptase inhibitors (NRTIs) significantly and independently reduced the risk of DDIs (adjusted odds ratio [aOR], 0.02; 95% CI, 0.005–0.050; P < .0001) compared with non-nucleoside reverse-transcriptase inhibitor plus 2 NRTIs, whereas cART with boosted agents (protease inhibitors or elvitegravir) significantly increased the risk (aOR, 4.12; 95% CI, 3.34–5.10; P < .0001). Compared with propensity score–matched PLWH without DDIs, the presence of DDIs was associated with a $2693 additional cost per year (P < .0001). Conclusions The presence of DDIs is frequent and significantly increases health care costs in the aging population of PLWH.
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Affiliation(s)
- Ludivine Demessine
- Biostatistics and Clinical Research, Caen University Hospital, Caen, France
- Faculty of Pharmacy, Caen Normandy University, Caen, France
| | | | | | - Jade Ghosn
- INSERM UMR 1137, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- APHP, Department of Infectious Diseases, Bichat University Hospital, Paris, France
| | - Jean-Jacques Parienti
- Biostatistics and Clinical Research, Caen University Hospital, Caen, France
- Department of Infectious Diseases, Caen University Hospital, Caen, France
- Caen Normandy University, EA2656 Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Caen, France
- Correspondence: Jean-Jacques Parienti, MD, PhD, CHU de Caen Normandie, Avenue de la Côte de Nacre, F-14000, France ()
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Kong AM, Pozen A, Anastos K, Kelvin EA, Nash D. Non-HIV Comorbid Conditions and Polypharmacy Among People Living with HIV Age 65 or Older Compared with HIV-Negative Individuals Age 65 or Older in the United States: A Retrospective Claims-Based Analysis. AIDS Patient Care STDS 2019; 33:93-103. [PMID: 30844304 PMCID: PMC6939583 DOI: 10.1089/apc.2018.0190] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The number of people living with HIV (PLWH) ≥65 years is increasing in the United States. By 2035, the proportion of PLWH in this age group is projected to be 27%. As PLWH live longer, they face age-related comorbidities. We compared non-HIV disease and medication burden among PLWH (n = 2359) and HIV-negative individuals (n = 2,010,513) ≥65 years using MarketScan® Medicare Supplemental health insurance claims from 2009 to 2015. Outcomes were common diagnoses and medication classes, prevalence of non-HIV conditions, number of non-HIV conditions, and daily non-antiretroviral therapy (ART) medications over a 1-year period. We examined age-standardized prevalence rates and prevalence ratios (PRs) and fit multivariable generalized linear models, stratified by sex. PLWH were younger (mean 71 vs. 76 years) and a larger proportion were men (81% vs. 45%). The most common diagnoses among both cohorts were hypertension and dyslipidemia. Most non-HIV conditions were more prevalent among PLWH. The largest absolute difference was in anemia (29.6 cases per 100 people vs.11.7) and the largest relative difference was in hepatitis C (PR = 22.0). Unadjusted mean number of non-HIV conditions and daily non-ART medications were higher for PLWH (4.61 conditions and 3.79 medications) than HIV-negative individuals (3.94 and 3.41). In models, PLWH had significantly more non-HIV conditions than HIV-negative individuals [ratios: men = 1.272, (95% confidence interval, 1.233-1.312); women = 1.326 (1.245-1.413)]. Among those with >0 daily non-ART medications, men with HIV had significantly more non-ART medications than HIV-negative men [ratio = 1.178 (1.133-1.226)]. The disease burden associated with aging is substantially higher among PLWH, who may require additional services to effectively manage HIV and comorbid conditions.
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Affiliation(s)
- Amanda M. Kong
- Department of Epidemiology and Biostatistics, City University of New York, Graduate School of Public Health and Health Policy, New York, New York
- Department of Life Sciences, IBM Watson Health, Cambridge, Massachusetts
| | - Alexis Pozen
- Department of Health Policy and Management, City University of New York, Graduate School of Public Health and Health Policy, New York, New York
| | | | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, City University of New York, Graduate School of Public Health and Health Policy, New York, New York
| | - Denis Nash
- Department of Epidemiology and Biostatistics, City University of New York, Graduate School of Public Health and Health Policy, New York, New York
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KARA E, İNKAYA AÇ, AYDIN HAKLI D, DEMİRKAN K, ÜNAL S. Polypharmacy and drug-related problems among people living with HIV/AIDS: a single-center experience. Turk J Med Sci 2019; 49:222-229. [PMID: 30761883 PMCID: PMC7350848 DOI: 10.3906/sag-1807-295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background/aim The HIV-infected population is aging, and the concomitant comorbidities increase the likelihood of polypharmacy. There is a scarcity of data for determining drug-related problems in people living with HIV/AIDS (PLWHA). Materials and methods This cross-sectional study was carried out between 1 September 2015 and 1 July 2016. All patients underwent a face-to-face interview with a clinical pharmacist. PCNE Classification V 7.0 was used classify incident drug-related problems (DRPs). Results The mean age of the patients was 40.4 ± 13.06 years. The rate of polypharmacy was 66.1% in patients with comorbidities and 12.3% in those without comorbidities (P < 0.001). DRPs were more prominent in older patients (46 vs. 37 years, P < 0.001), those with longer durations of antiretroviral therapy (ART) (45 vs. 27 months, P = 0.014), and those with lower education levels (P = 0.013). Receiving >3 ART drugs was associated with more DRPs in the logistic regression model (odds ratio: 8.299, 95% confidence interval: 1.924–35.803). Fifty-eight interventions were performed in 45 (24.9%) patients. Clinical pharmacist interventions were performed in 18.9% of patients without polypharmacy and in 38.9% of patients with polypharmacy (P < 0.001). Conclusion DRPs and polypharmacy are common among elderly PLWHA. More interventions are warranted to boost the quality of life in aging PLWHA.
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Affiliation(s)
- Emre KARA
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ahmet Çağkan İNKAYA
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Hospitals, AnkaraTurkey
| | - Duygu AYDIN HAKLI
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Kutay DEMİRKAN
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, AnkaraTurkey
| | - Serhat ÜNAL
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Hospitals, AnkaraTurkey
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Capetti A, Rizzardini G. Choosing appropriate pharmacotherapy for drug-resistant HIV. Expert Opin Pharmacother 2019; 20:667-678. [DOI: 10.1080/14656566.2019.1570131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Amedeo Capetti
- Divisione Malattie Infettive, Aziende Socio Sanitarie Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Giuliano Rizzardini
- Divisione Malattie Infettive, Aziende Socio Sanitarie Territoriale Fatebenefratelli Sacco, Milano, Italy
- Faculty of Health Sciences, School of Clinical Medicine, Whitwaterstrand University, Johannesburg, South Africa
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Park MS, Yang YM, Kim JS, Choi EJ. Comparative study of antiretroviral drug regimens and drug-drug interactions between younger and older HIV-infected patients at a tertiary care teaching hospital in South Korea. Ther Clin Risk Manag 2018; 14:2229-2241. [PMID: 30519031 PMCID: PMC6237144 DOI: 10.2147/tcrm.s175704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background With the advent of combination antiretroviral therapy (ART), people living with HIV have lived to older age. So they have experienced age-related illnesses and have taken non-antiretroviral (ARV) medications to manage these illnesses. The aims of this study were to investigate the use patterns of ARV agents in HIV-positive patients by age and to evaluate potential or contraindicated drug-drug interactions (DDIs) between ARV and non-ARV. Methods This study was retrospectively conducted with HIV-infected patients receiving ART medications between October 2011 and September 2017 at Chonbuk National University Hospital in South Korea. Data were collected by reviewing patients' electronic medical charts. Results Among 207 patients diagnosed with HIV infection, 183 (86.9% males; 104 aged <50 years and 79 aged ≥50 years) were selected based on inclusion criteria. In 2017, the most frequently prescribed ART regimen was nucleoside reverse transcriptase inhibitors (NRTIs)/integrase strand transfer inhibitors (INSTIs; total, 66.3%; <50 years, 36.3%; ≥50 years, 30.0%) followed by NRTIs/protease inhibitors (PIs; total, 23.8%; <50 years, 15.0%; ≥50 years, 8.8%). In 2017, the most frequently prescribed NRTI combination was abacavir/lamivudine (total, 34.4%; <50 years, 20.6%; ≥50 years, 13.8%) followed by tenofovir alafenamide/emtricitabine (FTC; total, 31.3%; <50 years, 16.3%; ≥50 years, 15.0%) and tenofovir disoproxil fumarate/FTC (total, 28.1%; <50 years, 16.9%; ≥50 years, 11.3%). In 2017, elvitegravir (EVG)/cobicistat (COBI; total, 57.1%; <50 years, 30.4%; ≥50 years, 26.8%) was most frequently prescribed followed by dolutegravir (total, 32.1%; <50 years, 19.6%; ≥50 years, 12.5%). Potential or contraindicated DDIs between boosted PIs with ritonavir or EVG/COBI and coprescribed drugs occurred most frequently. Conclusion Currently, NRTIs/INSTIs is the most frequently prescribed ARV combination. Abacavir/lamivudine, tenofovir alafenamide/FTC, and tenofovir disoproxil fumarate/FTC are the most used NRTIs, and EVG/COBI followed by dolutegravir is the most prescribed INSTIs. Potential or contraindicated DDIs occur mainly between boosted PIs or EVG/COBI and non-ARV medications.
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Affiliation(s)
- Mi Seon Park
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, South Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea,
| | - Ju-Sin Kim
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, South Korea
| | - Eun Joo Choi
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea,
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49
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Ruzicka DJ, Imai K, Takahashi K, Naito T. Greater burden of chronic comorbidities and co-medications among people living with HIV versus people without HIV in Japan: A hospital claims database study. J Infect Chemother 2018; 25:89-95. [PMID: 30396821 DOI: 10.1016/j.jiac.2018.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the prevalence of chronic comorbidities and the use of co-medications among people living with HIV (PLWH) on antiretrovirals in Japan, compared with age-matched controls without HIV. METHODS This was an observational, retrospective, cross-sectional study using a hospital claims database of Japanese hospitals with advanced medical capabilities (i.e., advanced treatment hospitals, general hospitals, acute care hospitals). We extracted data for PLWH aged ≥18 years with a prescription record of antiretrovirals between January 2010 and December 2015, and for age-, sex-, and hospital-matched people without HIV. For each group, chronic comorbidities (diabetes, hypertension, lipid disorders, vascular diseases, chronic kidney failure, cancers, psychiatric disorders, osteoporosis, and hepatitis B/C co-infection), and co-medications were examined by age group. RESULTS We analyzed data for 1445 PLWH and 14,450 people without HIV. The proportion of patients with multiple comorbidities was much greater among PLWH than controls of the same age group. Lipid disorders and diabetes were more prevalent in PLWH than controls (31.6% vs. 10.3% and 26.8% vs. 13.2%, respectively), both of which were more common in PLWH at earlier ages. Cancer was present in 8.1% of PLWH and 8.9% of controls. A greater proportion of PLWH used multiple co-medications other than antiretrovirals at earlier ages than controls. CONCLUSION PLWH taking antiretrovirals in Japan had a greater burden of comorbidities and co-medications with increasing age than people without HIV. In addition to appropriate management of comorbidities, medication reconciliation according to patients' co-medication profiles is important for successful management of this patient population.
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Affiliation(s)
- Daniel J Ruzicka
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan.
| | - Kentaro Imai
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, USA
| | - Kenichi Takahashi
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Ruzicka DJ, Imai K, Takahashi K, Naito T. Comorbidities and the use of comedications in people living with HIV on antiretroviral therapy in Japan: a cross-sectional study using a hospital claims database. BMJ Open 2018; 8:e019985. [PMID: 29903786 PMCID: PMC6009456 DOI: 10.1136/bmjopen-2017-019985] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of chronic comorbidities and the use of comedications in people living with HIV (PLWH) and on antiretrovirals in Japan, by using a hospital claims database. DESIGN Observational, retrospective, cross-sectional study. SETTING A hospital claims database of Japanese hospitals that have advanced medical treatment capabilities (ie, advanced treatment hospitals, general hospitals, acute care hospitals), which include those providing acute and chronic care (excluding nursing homes or hospices). PARTICIPANTS A total of 1445 PLWH aged ≥18 years and with a prescription record of antiretrovirals between January 2010 and December 2015 were identified from the database. OUTCOME MEASURES The number and types of chronic comorbidities, as well as the number and types of comedications, in different age groups of the PLWH. RESULTS The median (range) age of patients was 45 (18-90) years, and 90.4% were men. Of the 1445 patients, 972 (67.3%) had at least one chronic comorbidity. Common chronic comorbidities included lipid disorders (31.6%), diabetes (26.8%), hypertension (18.2%) and hepatitis B/C coinfection (18.2%). Patients in the older age groups had greater numbers of chronic comorbidities. The most common chronic comorbidities in the older age groups were hypertension, diabetes and lipid disorders. The majority of patients used at least one comedication, and those in the older age groups used greater numbers of comedications. The most common therapeutic category of comedication included antacids, antiflatulents and antiulcerants (31.7%). Of 151 malignancies reported in 117 patients, 84 were AIDS-defining cancers and 67 were non-AIDS-defining cancers. CONCLUSIONS Chronic comorbidities and comedications were common among PLWH in Japan taking antiretrovirals; particularly among older patients, who more frequently used comedications. This suggests the need for giving special attention to the appropriate management of this patient population.
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Affiliation(s)
| | - Kentaro Imai
- Oncology Clinical Development, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Toshio Naito
- Department of General Medicine, Juntendo University, Tokyo, Japan
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