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Brüne B, Sonderer S, Bösing M, Hübner S, Dongre K, Späni S, Holboro A, Leuppi JD, Leuppi-Taegtmeyer AB. Assessing potential risk factors for metamizole-induced leukopenia. Ther Adv Drug Saf 2024; 15:20420986241275255. [PMID: 39314989 PMCID: PMC11418300 DOI: 10.1177/20420986241275255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 07/31/2024] [Indexed: 09/25/2024] Open
Abstract
Background Metamizole is a non-opioid analgesic agent that can rarely cause agranulocytosis, a severe form of leukopenia. Objectives The aim of this study was to assess previously identified potential risk factors for the development of metamizole-induced leukopenia. Design A retrospective, observational, matched case-control study was performed in a single-center setting. Methods Patients who developed leukopenia in the setting of metamizole therapy were included as cases and matched 1:3 on the basis of age and sex to control patients who did not develop leukopenia when treated with metamizole. The data were obtained from the medical records of patients hospitalized at Cantonal Hospital Baselland between 2015 and 2020. Univariate and multivariate analyses were performed. Results Eighty-six cases and 258 matched controls aged between 18 and 102 years were included. Fifty-seven percent were female. Previous leukopenic episodes (odds ratio (OR): 4.02, 95% CI: 1.95-8.28, p < 0.001) and a history of penicillin allergy (OR: 2.49, 95% CI: 1.03-6.03, p = 0.044) were found to be independent risk factors for metamizole-induced leukopenia. Conclusion A history of previous leukopenic episodes and a history of penicillin allergy were confirmed as risk factors for metamizole-induced leukopenia. In our opinion, metamizole should be avoided in patients with these risk factors.
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Affiliation(s)
- Birgit Brüne
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Sarah Sonderer
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria Bösing
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- University of Basel, Basel, Switzerland
| | - Simona Hübner
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Kanchan Dongre
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Basel, Switzerland
| | - Selina Späni
- Clinical Pharmacology and Clinical Pharmacy, Hospital Pharmacy, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Andreas Holboro
- University of Basel, Basel, Switzerland
- Regional Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jörg D. Leuppi
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- University of Basel, Basel, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- University of Basel, Spitalstrasse 22, Basel 4031, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Basel, Switzerland
- Clinical Pharmacology and Clinical Pharmacy, Hospital Pharmacy, Cantonal Hospital Baselland, Liestal, Switzerland
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2
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Lerman TT, Sagi M, Shafir Y, Sheena L, Cohen E, Goldberg E, Krause I. A possible increased risk of metamizole-associated neutropenia among COVID-19 patients. Br J Clin Pharmacol 2021; 87:2902-2906. [PMID: 33332642 DOI: 10.1111/bcp.14703] [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: 10/09/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 01/29/2023] Open
Abstract
Metamizole is commonly used as analgesic and antipyretic drug. The use of metamizole is prohibited in several countries due to its rare side effect of neutropenia and even agranulocytosis. Among the many symptoms of COVID-19, fever and diffuse pain predominant and therefore it can be assumed that metamizole may be widely used in the current epidemic period. So far, there have been no reports on the safety of metamizole in COVID-19 patients. We describe a series of 3 patients who developed severe neutropenia under metamizole treatment, raising a concern of a possible increased risk of this side effect among COVID-19 patients.
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Affiliation(s)
- Tsahi T Lerman
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Moshe Sagi
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Yair Shafir
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Liron Sheena
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Eytan Cohen
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Elad Goldberg
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ilan Krause
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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3
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Rashti R, Sharafi H, Alavian SM, Moradi Y, Mohamadi Bolbanabad A, Moradi G. Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers. Pathogens 2020; 9:pathogens9060432. [PMID: 32486342 PMCID: PMC7350380 DOI: 10.3390/pathogens9060432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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Affiliation(s)
- Roya Rashti
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Heidar Sharafi
- Middle East Liver Diseases Center, Tehran 1598976513, Iran;
| | - Seyed Moayed Alavian
- Professor of Gastroenterology and Hepatology, Middle East Liver Disease Center, Tehran 1598976513, Iran;
| | - Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
- Correspondence:
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4
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Rudin D, Spoendlin J, Cismaru AL, Liakoni E, Bonadies N, Amstutz U, Meier CR, Krähenbühl S, Haschke M. Metamizole-associated neutropenia: Comparison of patients with neutropenia and metamizole-tolerant patients. Eur J Intern Med 2019; 68:36-43. [PMID: 31383393 DOI: 10.1016/j.ejim.2019.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022]
Abstract
Reports of metamizole-induced neutropenia have increased in Switzerland and Germany over the last decades, most likely reflecting increased use of metamizole. To date, there are no effective strategies to identify patients at increased risk of metamizole-induced neutropenia. In this observational, multi-center comparative study, characteristics of patients with metamizole-associated neutropenia were compared with patients treated with metamizole without developing adverse hematological reactions. Patients with metamizole-induced neutropenia treated at the University Hospitals Basel and Bern between 2005 and 2017 were included. Tolerant comparison patients with continuous metamizole treatment (≥500 mg/day for at least 28 days) were recruited from GP offices and community pharmacies. Forty-eight patients with metamizole-induced neutropenia, consisting of 23 and 25 cases with inpatient-acquired and outpatient-acquired neutropenia, respectively, were compared to 39 metamizole tolerant comparison patients. Median latency until first diagnosis of neutropenia was 6 days (1-61 days) in inpatient cases and 19 days (2-204 days) in outpatient cases. There was no association between non-myelotoxic and non-immunosuppressive co-medication (p = .6627), history of drug allergy (p = .1304), and preexisting auto-immune diseases (p = .2313) and the development of metamizole-induced neutropenia. Our results suggest that autoimmune diseases, history of drug allergy, and concomitant treatment with non-myelotoxic and non-immunosuppressive drugs are likely not individual risk factors for metamizole-associated neutropenia.
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Affiliation(s)
- Deborah Rudin
- Division of Clinical Pharmacology & Toxicology, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland; Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, University of Basel, St. Johanns-Vorstadt 27, 4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031 Basel, Switzerland.
| | - Anca L Cismaru
- Division of Clinical Chemistry, Inselspital Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; Institute of Pharmacology, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Ursula Amstutz
- Division of Clinical Chemistry, Inselspital Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, University of Basel, St. Johanns-Vorstadt 27, 4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031 Basel, Switzerland.
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology & Toxicology, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland; Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; Institute of Pharmacology, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
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5
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Oumar AA, Dakouo M, Tchibozo A, Maiga M, Landouré G, Abdi-Bogoreh R, Tulkens PM, Dao S, Yombi JC. Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience. ACTA ACUST UNITED AC 2019; 8:831-836. [PMID: 31879663 PMCID: PMC6931397 DOI: 10.18203/2319-2003.ijbcp20191565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population. Methods This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo's classification scale. Results During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others. Conclusions Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.
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Affiliation(s)
| | - Mamadou Dakouo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Anicet Tchibozo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Mamoudou Maiga
- Department of Global Health, Northwestern University, Chicago, USA
| | - Guida Landouré
- Department of Neurology, Centre Hospital, University du Point «G», Bamako, Mali
| | | | - Paul M Tulkens
- Department of Cellular & Molecular Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Sounkalo Dao
- Department of Infectious Diseases, Centre Hospital, University du Point «G», Bamako
| | - Jean Cyr Yombi
- Department of Internal Medicine & Infectious Diseases, AIDS Reference Center, Catholic University of Louvain, Brussels, Belgium
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6
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Velen K, Charalambous S, Innes C, Churchyard GJ, Hoffmann CJ. Chronic hepatitis B increases mortality and complexity among HIV-coinfected patients in South Africa: a cohort study. HIV Med 2016; 17:702-7. [PMID: 26991340 PMCID: PMC6717432 DOI: 10.1111/hiv.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the effect of chronic hepatitis B on survival and clinical complexity among people living with HIV following antiretroviral therapy (ART) initiation. METHODS We evaluated mortality and single-drug substitutions up to 3 years from ART initiation (median follow-up 2.75 years; interquartile range 2-3 years) among patients with and without chronic hepatitis B (CHB) enrolled in a workplace HIV care programme in South Africa. RESULTS Mortality was increased for CHB patients with hepatitis B virus (HBV) DNA levels > 10 000 copies/mL (adjusted hazard ratio 3.1; 95% confidence interval 1.2-8.0) compared with non-CHB patients. We did not observe a similar difference between non-CHB patients and those with CHB and HBV DNA < 10 000 copies/mL (adjusted hazard ratio 0.70; 95% confidence interval 0.2-2.3). Single-drug substitutions occurred more frequently among coinfected patients regardless of HBV DNA level. CONCLUSIONS Our findings suggest that CHB may increase mortality and complicate ART management.
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Affiliation(s)
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Craig Innes
- The Aurum Institute, Johannesburg, South Africa
| | - Gavin J Churchyard
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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7
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Shen YZ, Wang ZY, Qi TK, Jiang XY, Song W, Tang Y, Wang JR, Liu L, Zhang RF, Zheng YF, Dai ZS, Lu HZ. Serological survey of viral hepatitis markers among newly diagnosed patients with HIV/AIDS in China. HIV Med 2012; 14:167-75. [DOI: 10.1111/j.1468-1293.2012.01048.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 01/29/2023]
Affiliation(s)
- YZ Shen
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZY Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - TK Qi
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - XY Jiang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - W Song
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - Y Tang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - JR Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - L Liu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - RF Zhang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - YF Zheng
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZS Dai
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - HZ Lu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
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8
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The importance of drug-drug interactions as a cause of adverse drug reactions: a pharmacovigilance study of serotoninergic reuptake inhibitors in France. Eur J Clin Pharmacol 2011; 68:767-75. [PMID: 22116460 DOI: 10.1007/s00228-011-1156-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To quantify the importance of drug-drug interactions (DDIs) in the occurrence of adverse drug reactions (ADRs) reported with serotoninergic reuptake inhibitors in a pharmacovigilance database. METHODS All spontaneous reports of ADRs registered in 2008 by the Midi-Pyrénées PharmacoVigilance Centre that contained mention of one of the serotoninergic reuptake inhibitor (SRI) antidepressants marketed in France were reviewed. DDIs were identified according to the French National Drug Formulary (Vidal) and the interaction supplement of the French independent drug bulletin La Revue Prescrire. ADRs explained by DDIs were characterised. RESULTS Among the 2,101 spontaneous reports recorded, 177 involved at least one SRI antidepressant. Among the 156 ADRs with at least one theoretical DDI, 41% (95% confidence interval 34-49%) could be explained by a DDI. The most frequent antidepressant involved in DDIs was escitalopram, followed by fluoxetine and citalopram. Among the 65 ADRs related to DDIs, 37 (52.9%) were "serious", mainly bleedings, confusion and falls, hyponatremia and serotoninergic syndromes. The most frequent drug interactions occurred with psychotropics (antipsychotics, benzodiazepines, among others), followed by antithrombotic agents (antagonists of vitamin K, antiplatelets), diuretics and angiotensin II antagonists. The group with ADRs related to DDIs was older than the group with ADRs not related to DDIs. ADRs were threefold more "serious" in the case of DDIs. CONCLUSION Around 40% of ADRs reported with SRIs were related to DDIs. Most of these occurred after association with psychotropics, antithrombotics, or diuretics, especially in the elderly.
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Murugan K, Prabu RV, Sangeetha S, Al-Sohaibani S. Antiviral Activity ofCardiospermum HalicacabumL. Extract against Coinfecting Agents HIV and HBV. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/10496475.2011.605515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Chen JJ, Yu CB, Du WB, Li LJ. Prevalence of hepatitis B and C in HIV-infected patients: a meta-analysis. Hepatobiliary Pancreat Dis Int 2011; 10:122-7. [PMID: 21459717 DOI: 10.1016/s1499-3872(11)60020-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share similar routes of transmission by sexual intercourse or drug use by parenteral injection, so coinfection is common. This study aimed to determine the prevalence of coinfection with either HCV or HBV in patients infected with HIV. DATA SOURCES A meta-analysis was performed to quantify HBV coinfection with HCV in HIV patients. Published studies in the English and Chinese language medical literature involving cohorts of HIV patients concomitantly infected with HBV and/or HCV were collected from the PubMed database, ISI Web of Science, the Cochrane library clinical trials registry, CNKI (China National Knowledge Infrastructure) and Google Scholar, for relevant articles before November 2009. The search was conducted with the following key words: hepatitis C, HCV, hepatitis B, HBV, human immunodeficiency virus, HIV, and coinfection. Data were extracted from relevant studies by two investigators. RevMan 5.0 software was used to perform the meta-analysis. RESULTS We identified 22 studies involving 17 664 patients. Substantial differences in the HCV rate compared to the HBV rate in HIV patients were found in the overall analysis [odds ratio (OR)=3.00; 95% confidence interval (CI) 1.90-4.73]. A subgroup analysis showed similar results in a European group, but not in Asian or African groups. However, a meta-analysis between HIV+HBV+HCV+ and HIV+HBV+HCV- patients showed no significant difference (OR=0.91; 95% CI 0.57-1.45). Although subgroup analysis still lacked essential differences, different regions seemed to have different patterns. CONCLUSIONS HCV-HIV coinfection is more frequent than HBV-HIV coinfection overall. However, HCV infection does not affect the prevalence of HBV infection in HIV-positive patients.
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Affiliation(s)
- Jia-Jia Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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11
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Shah M. A prospective analysis of adverse effects of antiretroviral agents: Additional points to consider. Indian J Pharmacol 2010; 42:116. [PMID: 20711381 PMCID: PMC2907011 DOI: 10.4103/0253-7613.64491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Megha Shah
- Department of Pharmacology, Medical College, Vadodara, Gujarat
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12
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Wise M, Finelli L, Sorvillo F. Prognostic factors associated with hepatitis C disease: a case-control study utilizing U.S. multiple-cause-of-death data. Public Health Rep 2010; 125:414-22. [PMID: 20433036 DOI: 10.1177/003335491012500310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Hepatitis C, an important cause of premature mortality, is the most common chronic bloodborne infection in the United States. The severity of disease is strongly affected by a number of other medical conditions and health behaviors. We sought to estimate the association of several exposures with hepatitis C on death certificates. METHODS We enrolled 63,189 hepatitis C deaths as cases in a case-control study using multiple-cause-of-death data for the U.S. from 1999 to 2004. Three control groups were assembled from all remaining deaths with no mention of hepatitis C, including a random sample of all deaths, digestive disease deaths, and circulatory disease deaths. RESULTS Hepatitis B, human immunodeficiency virus (HIV), hemochromatosis, and alcohol use were all strongly associated with hepatitis C, even after controlling for confounding variables. The simultaneous presence of many of these exposures had a synergistic association with hepatitis C being listed as a cause of death. Hepatitis B, HIV, and alcohol use were recorded among 6.4%, 10.5%, and 18.2% of case deaths, respectively. CONCLUSIONS The strong association of alcohol use, HIV, and hepatitis B with hepatitis C, as well as the frequent occurrence of these conditions, indicates that targeted interventions for mitigating the potential effect of these exposures may present an efficient means of limiting progression of hepatitis C-related liver disease and reducing the population burden of hepatitis C mortality.
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Affiliation(s)
- Matthew Wise
- Department of Epidemiology, University of California, Los Angeles, School of Public Health, Los Angeles, CA, USA.
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Mikl J, Sulkowski MS, Benhamou Y, Dieterich D, Pol S, Rockstroh J, Robinson PA, Ranga M, Stern JO. Hepatic profile analyses of tipranavir in Phase II and III clinical trials. BMC Infect Dis 2009; 9:203. [PMID: 20003457 PMCID: PMC2803791 DOI: 10.1186/1471-2334-9-203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022] Open
Abstract
Background The risk and course of serum transaminase elevations (TEs) and clinical hepatic serious adverse event (SAE) development in ritonavir-boosted tipranavir (TPV/r) 500/200 mg BID recipients, who also received additional combination antiretroviral treatment agents in clinical trials (TPV/r-based cART), was determined. Methods Aggregated transaminase and hepatic SAE data through 96 weeks of TPV/r-based cART from five Phase IIb/III trials were analyzed. Patients were categorized by the presence or absence of underlying liver disease (+LD or -LD). Kaplan-Meier (K-M) probability estimates for time-to-first US National Institutes of Health, Division of AIDS (DAIDS) Grade 3/4 TE and clinical hepatic SAE were determined and clinical actions/outcomes evaluated. Risk factors for DAIDS Grade 3/4 TE were identified through multivariate Cox regression statistical modeling. Results Grade 3/4 TEs occurred in 144/1299 (11.1%) patients; 123/144 (85%) of these were asymptomatic; 84% of these patients only temporarily interrupted treatment or continued, with transaminase levels returning to Grade ≤ 2. At 96 weeks of study treatment, the incidence of Grade 3/4 TEs was higher among the +LD (16.8%) than among the -LD (10.1%) patients. K-M analysis revealed an incremental risk for developing DAIDS Grade 3/4 TEs; risk was greatest through 24 weeks (6.1%), and decreasing thereafter (>24-48 weeks: 3.4%, >48 weeks-72 weeks: 2.0%, >72-96 weeks: 2.2%), and higher in +LD than -LD patients at each 24-week interval. Treatment with TPV/r, co-infection with hepatitis B and/or C, DAIDS grade >1 TE and CD4+ > 200 cells/mm3 at baseline were found to be independent risk factors for development of DAIDS Grade 3/4 TE; the hazard ratios (HR) were 2.8, 2.0, 2.1 and 1.5, respectively. Four of the 144 (2.7%) patients with Grade 3/4 TEs developed hepatic SAEs; overall, 14/1299 (1.1%) patients had hepatic SAEs including six with hepatic failure (0.5%). The K-M risk of developing hepatic SAEs through 96 weeks was 1.4%; highest risk was observed during the first 24 weeks and decreased thereafter; the risk was similar between +LD and -LD patients for the first 24 weeks (0.6% and 0.5%, respectively) and was higher for +LD patients, thereafter. Conclusion Through 96 weeks of TPV/r-based cART, DAIDS Grade 3/4 TEs and hepatic SAEs occurred in approximately 11% and 1% of TPV/r patients, respectively; most (84%) had no significant clinical implications and were managed without permanent treatment discontinuation. Among the 14 patients with hepatic SAE, 6 experienced hepatic failure (0.5%); these patients had profound immunosuppression and the rate appears higher among hepatitis co-infected patients. The overall probability of experiencing a hepatic SAE in this patient cohort was 1.4% through 96 weeks of treatment. Independent risk factors for DAIDS Grade 3/4 TEs include TPV/r treatment, co-infection with hepatitis B and/or C, DAIDS grade >1 TE and CD4+ > 200 cells/mm3 at baseline. Trial registration US-NIH Trial registration number: NCT00144170
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Affiliation(s)
- Jaromir Mikl
- SUNY at Albany, School of Public Health, Rensselaer NY, USA.
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Khalili H, Dashti-Khavidaki S, Mohraz M, Etghani A, Almasi F. Antiretroviral induced adverse drug reactions in Iranian human immunodeficiency virus positive patients. Pharmacoepidemiol Drug Saf 2009; 18:848-57. [PMID: 19551698 DOI: 10.1002/pds.1793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To our knowledge, there is no report regarding antiretroviral induced adverse drug reactions (ADRs) in Iranian patients who infected with human immunodeficiency virus (HIV). We have evaluated the frequency of antiretroviral therapy (ART) induced ADRs in this population and assessed some risk factors of these reactions. METHODS This is a prospective cohort study that was performed in Iranian Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Research Center during years 2005-2007. Adult patients who infected with HIV and newly started on ART were included in this study and followed laboratory and clinically for the development of any ADRs for at least 6 months. RESULTS During this study 87.6% of patients showed at least one ADR. Prevalence of ADRs based on affected organ was: gastrointestinal (GI) (63.7%), hematological (32.6%), neurological (30%), cutaneous (22%), musculoskeletal (21.3%), hepatic (20%), metabolic (18.6%), and renal (2.6%) adverse effects. CONCLUSIONS The most important results of this study were finding of hematological ADRs as the most common cause of ART interruption, supporting the hypersensitivity nature of antiretroviral induced hepatotoxicity especially cholestasis and new finding of the significant positive correlation between hepatitis C virus co-infection and the occurrence of ART induced skin reactions.
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Affiliation(s)
- Hossein Khalili
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Postal Code: 1417614411, Tehran, Iran.
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15
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Pirillo MF, Bassani L, Germinario EAP, Mancini MG, Vyankandondera J, Okong P, Vella S, Giuliano M. Seroprevalence of hepatitis B and C viruses among HIV-infected pregnant women in Uganda and Rwanda. J Med Virol 2007; 79:1797-801. [PMID: 17935164 DOI: 10.1002/jmv.21007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A retrospective survey to estimate the prevalence of hepatitis B (HBV) and C (HCV) infections was conducted on the samples of 247 African HIV-1 positive pregnant women who had participated to a mother-to-child prevention trial carried out in urban settings in Kampala, Uganda and Kigali, Rwanda. Hepatitis B markers studied were HBs antigen (HBsAg) and, if positive after confirmatory testing, HBe antigen/anti-HBe antibodies and HBV DNA. A fourth generation HCV enzyme immunoassay (EIA) was used for primary HCV screening. Positive samples were analyzed further with a second different EIA. Both for HBV and for HCV the use of confirmatory tests allowed the removal of frequent false-positive screening results. HBsAg was found in 10/246 women (seroprevalence 4.1%, 95% confidence interval (95%CI) 1.7-6.8): 8/164 (4.9%) in Uganda and 2/82 (2.4%) in Rwanda. HBe Ag was found in 33% of HBsAg-positive patients and HBV DNA was quantifiable in 71%. Anti-HCV antibodies were found in 5/247 women (seroprevalence 2.0% 95%CI 0.3-3.9): 1/165 (0.6%) in Uganda and 4/82 (4.9%) in Rwanda. There was no interrelation between HCV and HBV markers. There was no difference between patients with and without co-infection with HBV or HCV with regards to CD4+ cell count. Overall, hepatitis B and C co-infection was relatively infrequent in this group of pregnant women. However, since approximately 6% of HIV-positive women in these countries had a co-infection with one hepatitis virus, caution should be used in the monitoring of possible hepatotoxicity related to antiretroviral drugs in these populations.
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Affiliation(s)
- Maria F Pirillo
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Berthet S, Grolleau S, Brefel-Courbon C, Montastruc JL, Lapeyre-Mestre M. Prise en charge thérapeutique des patients diabétiques en France : Apport de la Banque Nationale de Pharmacovigilance. Therapie 2007; 62:483-8. [DOI: 10.2515/therapie:2007076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gaglio PJ, Sterling R, Daniels E, Tedaldi E. Hepatitis B Virus and HIV Coinfection: Results of a Survey on Treatment Practices and Recommendations for Therapy. Clin Infect Dis 2007; 45:618-23. [PMID: 17682998 DOI: 10.1086/520751] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/18/2007] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The management of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is challenged by the selection of patients for therapy, options for antiviral medications, and inconsistency in published treatment guidelines. METHODS A survey was sent to 161 sites in a multicenter HIV clinical trials group to assess HBV screening, criteria for initiation of therapy, and treatment choices for patients coinfected with HBV and HIV. RESULTS Of 161 sites, 78 completed the survey (response rate, 48.4%). Of these sites, 98.7% screened for HBV infection, 86% vaccinated HIV-infected patients who were not immune to HBV infection, and 79% made treatment decisions without referral to a hepatologist or gastroenterologist. Treatment recommendations varied; 42% of the sites initiated therapy when patients' levels of alanine aminotransferase and aspartate aminotransferase were elevated and HBV DNA level was >10(5) copies/mL, whereas 49% of the sites initiated therapy in the presence of any detectable HBV DNA level. Antiviral treatment choices for patients who were not concurrently receiving antiretroviral therapy were lamivudine plus tenofovir, adefovir, or interferon. Patients concurrently receiving antiretroviral therapy received lamivudine plus tenofovir preferentially, followed by tenofovir plus emtricitabine, adefovir, or interferon. Ninety-one percent of the sites screened for hepatocellular carcinoma. CONCLUSIONS The majority of HIV-infected patients were screened and vaccinated for HBV infection and underwent surveillance for hepatocellular carcinoma. Decisions regarding the performance of liver biopsy, threshold to initiate therapy, and criteria to discontinue therapy varied, reflecting inconsistencies in available treatment guidelines. Treatment decisions reflected concerns regarding future drug resistance in patients who are naive to antiretroviral therapy and the emergence of drug resistance in patients receiving antiretroviral therapy.
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Affiliation(s)
- Paul J Gaglio
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Zhou J, Dore GJ, Zhang F, Lim PL, Chen YMA. Hepatitis B and C virus coinfection in The TREAT Asia HIV Observational Database. J Gastroenterol Hepatol 2007; 22:1510-8. [PMID: 17645479 DOI: 10.1111/j.1440-1746.2007.05062.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Most studies of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection with HIV have been conducted among Western patient populations. This study aims to assess rates of HBV and HCV coinfection, and their impact on response to antiretroviral therapy and mortality, using data from The TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of patients with HIV in the Asia-Pacific region. METHODS Patients who had been tested either HBV surface antigen (HBsAg) or HCV antibody were included. Patients who ever tested positive for HBV or HCV were regarded as coinfected for the duration of the study. RESULTS Results of hepatitis tests were available for 55% (HBV) and 49% (HCV) of 2979 TAHOD patients, with prevalence of HBV and HCV coinfection both at approximately 10%. Mean CD4 change at 180 days after antiretroviral treatment initiation was 118.8 cells/muL and patients with either HBV or HCV had a lower but non-significant CD4 increase compared with patients with HIV only. Median time to reach undetectable viral load (<400 copies/mL) was 148 days and was not independently associated with HBV or HCV. In univariate analysis, patients with HCV had increased mortality (unadjusted hazard ratio, HR 2.80, P = 0.007). However, neither HBV (adjusted HR 0.80, 95% confidence interval CI 0.24-2.64, P = 0.710) nor HCV (adjusted HR 1.06, 95% CI 0.40-2.79, P = 0.905) was associated with increased mortality after adjustment for other covariates. Both HBV and HCV remained independently associated with elevated alanine aminotransferase (ALT) in the multivariate model (HBV, adjusted HR 1.94, 95% CI 1.04-3.62, P = 0.037; HCV, adjusted HR 2.74, 95% CI 1.47-5.12, P = 0.002). CONCLUSION The impact of hepatitis coinfection on immunological and virological responses to antiretroviral therapy and HIV disease progression among this Asian cohort are similar to that seen in Western countries. The longer-term impact of hepatitis coinfection on both HIV disease and liver disease morbidity and mortality needs to be monitored.
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Affiliation(s)
- Jialun Zhou
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia
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Tavassoli N, Sommet A, Lapeyre-Mestre M, Bagheri H, Montrastruc JL. Drug Interactions with Cholinesterase Inhibitors. Drug Saf 2007; 30:1063-71. [DOI: 10.2165/00002018-200730110-00005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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