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Cottura N, Kinvig H, Grañana-Castillo S, Wood A, Siccardi M. Drug-Drug Interactions in People Living with HIV at Risk of Hepatic and Renal Impairment: Current Status and Future Perspectives. J Clin Pharmacol 2022; 62:835-846. [PMID: 34990024 PMCID: PMC9304147 DOI: 10.1002/jcph.2025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022]
Abstract
Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug–drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be victims and perpetrators of DDIs, and a detailed investigation during drug discovery and development is required to determine whether dose adjustments are necessary or coadministrations are contraindicated. Maintaining therapeutic ARV plasma concentrations is essential for successful ART, and changes resulting from potential DDIs could lead to toxicity, treatment failure, or the emergence of ARV‐resistant HIV. The challenges surrounding DDI management are complex in special populations of people living with HIV, and often lack evidence‐based guidance as a result of their underrepresentation in clinical investigations. Specifically, the prevalence of hepatic and renal impairment in people living with HIV are between five and 10 times greater than in people who are HIV‐negative, with each condition constituting approximately 15% of non‐AIDS‐related mortality. Therapeutic strategies tend to revolve around the treatment of risk factors that lead to hepatic and renal impairment, such as hepatitis C, hepatitis B, hypertension, hyperlipidemia, and diabetes. These strategies result in a diverse range of potential DDIs with ART. The purpose of this review was 2‐fold. First, to summarize current pharmacokinetic DDIs and their mechanisms between ARVs and co‐medications used for the prevention and treatment of hepatic and renal impairment in people living with HIV. Second, to identify existing knowledge gaps surrounding DDIs related to these special populations and suggest areas and techniques to focus upon in future research efforts.
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Affiliation(s)
- Nicolas Cottura
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Hannah Kinvig
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | | | - Adam Wood
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Marco Siccardi
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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Szkodziak P, Czuczwar P, Pyra K, Szkodziak F, Paszkowski T, Tinto HR, Woźniak S. Ascites Index - an attempt to objectify the assessment of ascites. J Ultrason 2018; 18:140-147. [PMID: 30335923 PMCID: PMC6440512 DOI: 10.15557/jou.2018.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Ascites is observed in cancer patients as well as in other non-neoplastic processes. In some patients, it may cause severe symptoms that can become directly life-threatening. The assessment of the degree of ascites seems useful in the determination of treatment effects as well as in the monitoring of fluid accumulation and early planning of decompression procedures. Aim: Determination of the clinical usefulness of a quantitative method of determining the degree of ascites, so-called Ascites Index. Material and methods: The Ascites Index is an ultrasonographic way of assessing the grade of ascites. The examination result is an index which is analogous to the amniotic fluid index determined in pregnant patients. The Ascites Index was determined in patients with ascites in the course of stage III–IV ovarian carcinoma (7 patients) and ovarian hyperstimulation syndrome (12 patients). Results: The patients with ovarian hyperstimulation syndrome required decompressive paracentesis at the median Ascites Index above 290 mm (range: 216–386 mm). In the patients with ovarian carcinoma, the median value of the Ascites Index at which paracentesis was required was 310 mm (range: 273–389 mm). To avoid complications associated with excessive protein loss, 2000 mL of fluid was evacuated at a single occasion. Following the procedure, the median value of the Ascites Index was 129 mm (range: 121–145 mm) in the patients with ovarian hyperstimulation syndrome and 146 cm (119–220 mm) in cancer patients. Conclusions: The proposed index is simple and rapid to determine. It makes evaluation of the degree of ascites considerably easier. Moreover, it only minimally burdens patients and enables assessment of the effect of decompression or treatment. It seems that this method might be useful also in the assessment of ascites caused by other factors, but this requires further clinical studies.
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Affiliation(s)
- Piotr Szkodziak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Czuczwar
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Filip Szkodziak
- Student Study Group at the 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Hugo Rio Tinto
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Sławomir Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Oliveira RA, Turrini RNT, Poveda VDB. Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review. Am J Infect Control 2018; 46:88-93. [PMID: 28689978 DOI: 10.1016/j.ajic.2017.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation. The purpose of this integrative literature review is to summarize the knowledge available about the risk factors contributing to the development SSI among adults undergoing liver transplantation. METHODS We reviewed the Medical Literature Analysis and Retrieval System Online/PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature, Scopus, and Web of Science databases. RESULTS Two hundred sixteen articles were identified and the final sample of 9 articles was analyzed in full length. The SSI rate found in the investigations ranged between 9.6% and 35.5%. Risk factors for SSI were grouped into categories related to the preoperative period, such as Model for End-Stage Renal Disease score > 35 and ventilated support on day of transplant; to the intraoperative period activity, such as transfusion of packed red blood cells, extended surgical time, hyperglycemia >200 mg/dL, use of vasopressor drugs, and ascites flow >1 L; and to the donor/recipient relationship, such as age differences >10 years, ratio of donor liver mass to recipient body mass < 0.01. Additionally, centers that annually perform <50 transplants appear to have higher rates of SSI. CONCLUSIONS Few studies have addressed the subject of SSI in relation to liver transplantation in the scientific literature. Risk factors for SSI in patients who underwent liver transplantation vary between institutions.
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Hamel B, Guillaud O, Roman S, Vallin M, Pilleul F, Valette PJ, Henry L, Guibal A, Mion F, Dumortier J. Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt: From the liver to the kidney. Dig Liver Dis 2014; 46:1001-7. [PMID: 25096966 DOI: 10.1016/j.dld.2014.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the prognostic value of different scores (including Child-Pugh and Model for End Stage Liver Diseases) in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt for refractory ascites. METHODS Overall, 111 patients with transjugular intrahepatic porto-systemic shunt insertion between January 1998 and July 2012 were included. RESULTS Survival rates (without transplantation) were 82.0% at 3 months, and 59.4% at 1 year. In addition to standard parameters, a new simple classification based on platelet count and glomerular filtration rate showed strong prognostic ability and could distinguish 3 groups of patients (Log-rank test, p<0.001): a "good-prognosis" group with platelet counts above 125×10(9)L(-1) and a glomerular filtration rate above 90 mL/min (1-year survival rate 92%), a "poor-prognosis" group with platelet counts below 125×10(9)L(-1) and a glomerular filtration rate below 90 mL/min (1-year survival rate 34.8%), and an "intermediate-prognosis" group (1-year survival rate 58.2%). Multivariate analysis showed a hazard ratio of 6.34 for the intermediate class and of 12.623 for the high class. CONCLUSIONS A new and simple classification including platelet count and glomerular filtration rate is highly predictive of survival in patients with refractory ascites treated with transjugular intrahepatic porto-systemic shunt and could be used to select patients for this procedure.
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Affiliation(s)
- Benjamin Hamel
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Olivier Guillaud
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Sabine Roman
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Mélanie Vallin
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Frank Pilleul
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre-Jean Valette
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Luc Henry
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Aymeric Guibal
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - François Mion
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Jérôme Dumortier
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France.
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Bercu ZL, Fischman AM. Outcomes of transjugular intrahepatic portosystemic shunts for ascites. Semin Intervent Radiol 2014; 31:248-51. [PMID: 25177085 DOI: 10.1055/s-0034-1382792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Refractory ascites represents a devastating complication of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an efficacious option for patients for whom transplant is not an immediate option. Techniques to optimize the hepatic venous pressure gradient and the use of covered stents have reduced rates of hepatic encephalopathy and stent occlusion, respectively. Patients with a Model for End-Stage Liver Disease score less than 15, serum creatinine less than 2 mg/dL, and serum bilirubin less than 2 mg/dL are particularly suited for TIPS placement. TIPS is also effective for hepatic hydrothorax and for massive ascites in the posttransplant setting, although future investigations are necessary to elucidate risk factors and establish the effect on transplant-free survival.
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Affiliation(s)
- Zachary L Bercu
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aaron M Fischman
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Lasheen AE, Elzeftawy A, Ibrahim S, Attia M, Emam M. Implantation of a skin graft tube to create a saphenoperitoneal shunt for refractory ascites. Surg Today 2007; 37:622-5. [PMID: 17593487 DOI: 10.1007/s00595-006-3471-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 06/15/2006] [Indexed: 01/19/2023]
Abstract
PURPOSE We evaluated the effectiveness of placing a skin tube in the subcutaneous plane to manage refractory ascites by draining the ascitic fluid from the peritoneal cavity into the long saphenous vein. METHODS Twenty patients with refractory ascites underwent this technique which was performed in two stages. In the first stage, a thin piece of partial thickness skin graft was rolled into a tube and implanted in the subcutaneous plane of the lower abdomen and the upper thigh near and parallel to the upper segment of the long saphenous vein. In the second stage, which was done 3 months later, we anastomosed the upper end of the skin tube to the peritoneal cavity and the lower end of the skin tube to the long saphenous vein. The follow-up period was 4 years. RESULTS There was no mortality. The complications consisted of hematoma formation in two patients, wound infection in three, and ascitic fluid leakage from the upper anastomosis in three. All these complications were managed conservatively. CONCLUSION These findings show that creating a saphenoperitoneal shunt with a skin graft tube interposition is a novel, safe, and cost-effective technique of resolving the problem of refractory ascites.
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Affiliation(s)
- Ahmed E Lasheen
- Department of General Surgery and Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
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N/A, 许 顺, 崔 鹤. N/A. Shijie Huaren Xiaohua Zazhi 2005; 13:2050-2051. [DOI: 10.11569/wcjd.v13.i16.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Dumortier J, Pianta E, Le Derf Y, Bernard P, Bouffard Y, Boucaud C, Sagnard P, Delafosse B, Boillot O. Peritoneovenous shunt as a bridge to liver transplantation. Am J Transplant 2005; 5:1886-92. [PMID: 15996235 DOI: 10.1111/j.1600-6143.2005.00959.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intractable ascites carries great morbidity. The aim of this study was to determine the efficacy of peritoneovenous shunt (PVS) in patients listed for liver transplantation (LT). Between January 1999 and January 2004, PVS was inserted in 36 (30 males and 6 females) cirrhotic patients, 50.3 years of median age (range: 30-66), who failed multiple large-volume paracenteses and diuretic therapy, when listed for LT. Data were collected until LT or the present time, and were compared to an historical cohort (1997-1998) as control. No operative death occurred. Four patients died before LT in a median delay of 9 months after PVS insertion. PVS provided palliation for intractable ascites in 30 patients (83%). Renal function significantly improved (glomerular filtration rate (GFR) improved from 0.642 to 0.987 mL/s, p<0.05). Eighteen patients were transplanted in a median delay of 6 months (range: 3-12 months) after PVS insertion. When compared to the historical cohort of 18 patients, the occurrence of post-LT acute renal failure was significantly lower in the PVS group (3/18 vs. 13/18, p<0.05). Our results suggest that PVS might be beneficial in patients with refractory ascites waiting for LT and could prevent postoperative acute renal failure.
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Affiliation(s)
- Jérôme Dumortier
- Unité de Transplantation Hépatique, Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
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Reisfield GM, Wilson GR. Management of Intractable, Cirrhotic Ascites with an Indwelling Drainage Catheter. J Palliat Med 2003; 6:787-91. [PMID: 14622465 DOI: 10.1089/109662103322515365] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Gary M Reisfield
- Department of Community Health and Family Medicine, University of Florida Health Science Center-Jacksonville, Florida 32209, USA.
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