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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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Jiménez-Osorio AS, Jaen-Vega S, Fernández-Martínez E, Ortíz-Rodríguez MA, Martínez-Salazar MF, Jiménez-Sánchez RC, Flores-Chávez OR, Ramírez-Moreno E, Arias-Rico J, Arteaga-García F, Estrada-Luna D. Antiretroviral Therapy-Induced Dysregulation of Gene Expression and Lipid Metabolism in HIV+ Patients: Beneficial Role of Antioxidant Phytochemicals. Int J Mol Sci 2022; 23:5592. [PMID: 35628408 PMCID: PMC9146859 DOI: 10.3390/ijms23105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection has continued to be the subject of study since its discovery nearly 40 years ago. Significant advances in research and intake of antiretroviral therapy (ART) have slowed the progression and appearance of the disease symptoms and the incidence of concomitant diseases, which are the leading cause of death in HIV+ persons. However, the prolongation of ART is closely related to chronic degenerative diseases and pathologies caused by oxidative stress (OS) and alterations in lipid metabolism (increased cholesterol levels), both of which are conditions of ART. Therefore, recent research focuses on using natural therapies to diminish the effects of ART and HIV infection: regulating lipid metabolism and reducing OS status. The present review summarizes current information on OS and cholesterol metabolism in HIV+ persons and how the consumption of certain phytochemicals can modulate these. For this purpose, MEDLINE and SCOPUS databases were consulted to identify publications investigating HIV disease and natural therapies and their associated effects.
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Affiliation(s)
- Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
| | - Sinaí Jaen-Vega
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
| | - Eduardo Fernández-Martínez
- Laboratorio de Química Medicinal y Farmacología, Centro de Investigación en Biología de la Reproducción, Área Académica de Medicina, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Calle Dr. Eliseo Ramírez Ulloa no. 400, Col. Doctores, Pachuca Hidalgo 42090, Mexico;
| | - María Araceli Ortíz-Rodríguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Iztaccíhuatl 100 Col. Los Volcanes, Cuernavaca 62350, Mexico;
| | - María Fernanda Martínez-Salazar
- Facultad de Ciencias del Deporte, Facultad de Farmacia Universidad Autónoma del Estado de Morelos, Av. Universidad No. 1001 Col. Chamilpa, Cuernavaca 62209, Mexico;
| | - Reyna Cristina Jiménez-Sánchez
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
| | - Olga Rocío Flores-Chávez
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
| | - Esther Ramírez-Moreno
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico;
| | - José Arias-Rico
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
| | - Felipe Arteaga-García
- Coordinación de Enseñanza e Investigación, Hospital del Niño DIF Hidalgo, Carretera México-Pachuca km 82, Pachuca de Soto 42080, Mexico;
| | - Diego Estrada-Luna
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico; (A.S.J.-O.); (S.J.-V.); (R.C.J.-S.); (O.R.F.-C.); (J.A.-R.)
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Priyanka PSSL, Varma DM, Immadisetti K, Rajesh R, Vidyasagar S, Guddattu V. Recognition of possible risk factors for clinically significant drug-drug interactions among Indian people living with HIV receiving highly active antiretroviral therapy and concomitant medications. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2018; 29:25-55. [PMID: 28885219 DOI: 10.3233/jrs-170738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Greatest challenges for clinician is to recognize risk factors for clinically significant drug interactions (CSDIs). There is a lack of awareness about CSDIs among healthcare professionals in India. OBJECTIVE To recognize all possible risk factors for drug-drug interactions (DDIs) and to identify clinically significant drug interactions (CSDIs), the prevalence, pattern of occurrence of DDIs in People Living with HIV (PLW-HIV) receiving highly active antiretroviral therapy (HAART) and concomitant medications. METHODS A retrospective medical record review was carried out by clinical pharmacist with ethics committee approval. Case files of HIV patients receiving HAART with concomitant medications were analyzed for CSDIs using University of Liverpool drug interaction database and CSDIs were classified based on red flag indication (RFI) or contraindicated drug-drug interaction (XDDIs) and orange flag indication (OFI) or DDIs that needs close monitoring. Patients with DDIs (cases) and patients without DDIs (controls) were compared with Chi-square tests. P value <0.05 was considered as statistically significant. RESULTS A total of 240 HIV patients' cases were screened. Out of which 267 DDIs were reported in 107 patients. Prevalence of DDIs was higher in male 71 (66.4%) compared to female 36 (33.6%). On zero-inflated poisson regression analysis, factors of polypharmacy, opportunistic infections, comorbid condition like Ischemic heart disease, respiratory tract infections, and psychiatric disorder were found to be predictors of high risk factors for DDIs to HAART. Fourteen XDDIs with RFI and two hundred fifty three DDIs with OFI were reported. XDDIs were atazanavir with fluconazole 4 (28.6%), ritonavir with fluconazole 4 (28.6%), nevirapine with rifampicin 2 (14.4%), ritonavir with quetiapine, atazanavir with pantoprazole. Pharmacokinetic DDIs were highest 238 (89.1%). Sixteen DDIs were reported in a single patient. The majority 97 (90.6%) patients had developed ≤5 DDIs, 8 (7.5%) developed six to eleven DDIs. The highest DDIs were reported with efavirenz 49 (18.4%) and zidovudine 44 (16.5%) based HAART regimen. CONCLUSION In India, with the increasing access to HAART usage, Clinician must focus to pay attention to recognize possible risk factors for CSDIs associated with HAART regimen and strictly to avoid "Red Flag Indication combinations" while prescribing so as to prevent CSDIs.
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Affiliation(s)
- Poka Siva Sai Lakshmi Priyanka
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
| | | | - Kavyasri Immadisetti
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
| | - Radhakrishnan Rajesh
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
| | - Sudha Vidyasagar
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Department of Statistics, Manipal University, Manipal, Karnataka, India
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Molas E, Luque S, Retamero A, Echeverría-Esnal D, Guelar A, Montero M, Guerri R, Sorli L, Lerma E, Villar J, Knobel H. Frequency and severity of potential drug interactions in a cohort of HIV-infected patients Identified through a Multidisciplinary team. HIV CLINICAL TRIALS 2017; 19:1-7. [PMID: 29179644 DOI: 10.1080/15284336.2017.1404690] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Interactions between antiretroviral treatment (ART) and comedications are a concern in HIV-infected patients. This study aimed to determine the frequency and severity of potential drug-drug interactions (PDDIs) with ART in our setting. METHODS Observational study by a multidisciplinary team in 1259 consecutive HIV patients (March 2015-September 2016). Data on demographics, toxic habits, comorbidities, and current ART were collected. A structured questionnaire recorded concomitant medications (including occasional and over-the-counter drugs). PDDIs were classified into four categories: (1) no interactions, (2) mild (clinically non-significant), (3) moderate (requiring close monitoring or drug modification/dose adjustment), and (4) severe (contraindicated). STATISTICAL ANALYSIS chi-square test, logistic regression analysis. RESULTS In total, 881 (70%) patients took comedication, and 563 (44.7%) had ≥ PDDI. Forty-one comedicated patients (4.6%) had severe and 522 (59.2%) moderate PDDIs. Moderate PDDIs mainly involved cardiovascular (53.8%) and central nervous system (40.2%) drugs. Independent risk factors for PDDIs were ART containing a boosted protease inhibitor (odds ratio [OR]=9.11, 95% confidence interval [CI] 5.15-16.11; p = 0.0001) and/or non-nucleoside reverse transcriptase (NNRTI) (OR = 4.34, 95%CI 2.49-7.55; p = 0.0001), HCV co-infection (OR = 3.26, 95%CI 2.15-4.93; p = 0.0001), and use of two or more comedications (OR = 3.36, 95%CI 2.27-4.97; p = 0.0001). Adherence and effectiveness of ART were similar in patients with and without PDDIs. The team made 133 recommendations related to comedications (drug change or dose adjustment) or ART (drug switch or change in administration schedule). CONCLUSIONS Systematic evaluation detected a significant percentage of PDDIs requiring an intervention in HIV patients on ART. Monitoring and advice about drug-drug interactions should be part of routine practice.
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Affiliation(s)
- E Molas
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - S Luque
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Retamero
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - D Echeverría-Esnal
- b Pharmacy Department Hospital del Mar , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Guelar
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - M Montero
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - R Guerri
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - L Sorli
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - E Lerma
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - J Villar
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - H Knobel
- a Infectious Diseases Department, Hospital del Mar, Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
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Martínez-Salazar MF, Oaxaca-Navarro J, Leija-Salas A, García-Jiménez S, Sánchez-Alemán MA, Déciga-Campos M. Analysis of self-reported adverse reactions to efavirenz and drug interactions in a population with HIV in Mexico. Eur J Hosp Pharm 2017; 25:322-326. [PMID: 31157050 DOI: 10.1136/ejhpharm-2016-001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To analyse the most frequent self-reported adverse reactions (ARs), the durability and the causes of antiretrovirals (ARVs) regimens change, concomitant treatments and drug interactions related to the use of ARVs in a group of people living with HIV in Cuernavaca, Morelos, Mexico. Materials and methods Cross-sectional study conducted in a clinic specialising in HIV 'CAPASITS-Cuernavaca' in Mexico from February to June 2015. People who wanted to participate were given a questionnaire on demographic characteristics, adherence, concomitant treatments and ARs. To understand the clinical variables, the clinical records were reviewed. Quantitative variables were compared using Student's t-test for normal data and the Mann-Whitney U test for non-normal data. For comparisons between categorical variables, the χ2 test was used. All tests used a significance level of 0.05. Results A total of 96 people participated, and 218 ARs (mean= 2.3±1.9) were found. The most frequently encountered ARs were dizziness (53.1%), insomnia (21.9%) and lucid dreams (17.7%). Twenty-three people (24%) were polymedicated, and 18 potential interactions were detected in 12 people. Conclusions The results suggest that a thorough analysis of the possible drug interactions should be performed for polymedicated people on ARV treatment and that a protocol should be designed for the monitoring and management of AR to ensure a good adherence to ARV treatment.
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Affiliation(s)
- María Fernanda Martínez-Salazar
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Jesús Oaxaca-Navarro
- CAPASITS Cuernavaca, Servicios de Salud del Estado de Morelos, Cuernavaca, Morelos, México
| | - Alfonso Leija-Salas
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos Cuernavaca, Morelos, México
| | - Sara García-Jiménez
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos Cuernavaca, Morelos, México
| | - Miguel Angel Sánchez-Alemán
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Myrna Déciga-Campos
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
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