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De Bellis E, Donnarumma D, Zarrella A, Mazzeo SM, Pagano A, Manzo V, Mazza I, Sabbatino F, Corbi G, Pagliano P, Filippelli A, Conti V. Drug-Drug Interactions Between HIV Antivirals and Concomitant Drugs in HIV Patients: What We Know and What We Need to Know. Pharmaceutics 2024; 17:31. [PMID: 39861680 PMCID: PMC11768951 DOI: 10.3390/pharmaceutics17010031] [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: 11/30/2024] [Revised: 12/23/2024] [Accepted: 12/26/2024] [Indexed: 01/27/2025] Open
Abstract
Highly active antiretroviral therapy has led to a significant increase in the life expectancy of people living with HIV. The trade-off is that HIV-infected patients often suffer from comorbidities that require additional treatment, increasing the risk of Drug-Drug Interactions (DDIs), the clinical relevance of which has often not been determined during registration trials of the drugs involved. Therefore, it is important to identify potential clinically relevant DDIs in order to establish the most appropriate therapeutic approaches. This review aims to summarize and analyze data from studies published over the last two decades on DDI-related adverse clinical outcomes involving anti-HIV drugs and those used to treat comorbidities. Several studies have examined the pharmacokinetics and tolerability of different drug combinations. Protease inhibitors, followed by nonnucleoside reverse transcriptase inhibitors and integrase inhibitors have been recognized as the main players in DDIs with antivirals used to control co-infection, such as Hepatitis C virus, or with drugs commonly used to treat HIV comorbidities, such as lipid-lowering agents, proton pump inhibitors and anticancer drugs. However, the studies do not seem to be consistent with regard to sample size and follow-up, the drugs involved, or the results obtained. It should be noted that most of the available studies were conducted in healthy volunteers without being replicated in patients. This hampered the assessment of the clinical burden of DDIs and, consequently, the optimal pharmacological management of people living with HIV.
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Affiliation(s)
- Emanuela De Bellis
- School “Clinical and Translational Oncology (CTO)”, Scuola Superiore Meridionale, University of Naples “Federico II”, 80138 Naples, Italy; (E.D.B.); (D.D.)
| | - Danilo Donnarumma
- School “Clinical and Translational Oncology (CTO)”, Scuola Superiore Meridionale, University of Naples “Federico II”, 80138 Naples, Italy; (E.D.B.); (D.D.)
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84081 Baronissi, Italy; (A.Z.); (S.M.M.); (A.P.); (I.M.)
| | - Adele Zarrella
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84081 Baronissi, Italy; (A.Z.); (S.M.M.); (A.P.); (I.M.)
| | - Salvatore Maria Mazzeo
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84081 Baronissi, Italy; (A.Z.); (S.M.M.); (A.P.); (I.M.)
| | - Annarita Pagano
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84081 Baronissi, Italy; (A.Z.); (S.M.M.); (A.P.); (I.M.)
| | - Valentina Manzo
- Clinical Pharmacology Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, Italy; (V.M.); (A.F.)
| | - Ines Mazza
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84081 Baronissi, Italy; (A.Z.); (S.M.M.); (A.P.); (I.M.)
| | - Francesco Sabbatino
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (F.S.); (P.P.)
- Oncology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Graziamaria Corbi
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Pasquale Pagliano
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (F.S.); (P.P.)
- Infectious Diseases Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, Italy
| | - Amelia Filippelli
- Clinical Pharmacology Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, Italy; (V.M.); (A.F.)
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (F.S.); (P.P.)
| | - Valeria Conti
- Clinical Pharmacology Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, Italy; (V.M.); (A.F.)
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (F.S.); (P.P.)
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Lynam M, Keatley D, Maker G, Coumbaros J. The prevalence of selected licit and illicit drugs in drug facilitated sexual assaults. Forensic Sci Int Synerg 2024; 9:100545. [PMID: 39148950 PMCID: PMC11325276 DOI: 10.1016/j.fsisyn.2024.100545] [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] [Received: 05/28/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024]
Abstract
Little is known about the prevalence of incapacitating substances present in drug facilitated sexual assaults (DFSA). Presented here is a literature review conducted to provide background information, such as symptoms, exacerbations, and drug interactions, on drugs typically implicated in DFSA, namely gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), 1,4-butanediol (1,4-BD), ketamine, diazepam, oxycodone, methamphetamine, and alcohol. Literature found through Scopus and Pubmed was reviewed to determine the current prevalence of these substances in DFSA with a focus on Australian data. The global literature revealed that there is a wide variety of substances used in DFSA and the prevalence varied by country. For example, it was found that in Northern Ireland, opioids were most prevalent whereas in France, benzodiazepines were most prevalent. In Australia the review revealed a lack of contemporary data with the most recent report in Victoria using data collected during 2011-2013. The literature also revealed there can be an important difference between self-reported substance use and substances discovered via toxicological analysis. This can be due to the challenges of biological detection, reliability of self-reporting, and the possibility of a substance being introduced to a person's food or drink without their knowledge. This review highlights the need for the collection and analysis of current data pertaining to DFSA reports and the drugs detected, and due to the constantly evolving picture of both licit and illicit drug use an assessment of the role of prescription medications in DFSA due to drug-drug interactions as well as potential to incapacitate is warranted.
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Affiliation(s)
- Marie Lynam
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - David Keatley
- School of Law, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Garth Maker
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
- Centre for Computational and Systems Medicine, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - John Coumbaros
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
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De La Mora L, Nebot MJ, Martinez-Rebollar M, De Lazzari E, Tuset M, Laguno M, Ambrosioni J, Miquel L, Blanch J, Ugarte A, Torres B, González-Cordón A, Inciarte A, Chivite I, Short D, Salgado E, Martinez E, Blanco JL, Mallolas J. Do ART and Chemsex Drugs Get Along? Potential Drug-Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study. Infect Dis Ther 2022; 11:2111-2124. [PMID: 36173594 PMCID: PMC9669299 DOI: 10.1007/s40121-022-00694-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. METHODS We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). RESULTS Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60-1.8; p = 0.876). CONCLUSION One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach.
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Affiliation(s)
- Lorena De La Mora
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - María J. Nebot
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Maria Martinez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Montserrat Tuset
- grid.410458.c0000 0000 9635 9413Department of Pharmacy, Hospital Clinic, Barcelona, Spain
| | - Montserrat Laguno
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Juan Ambrosioni
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Laia Miquel
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Ainoa Ugarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Berta Torres
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Ana González-Cordón
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Alexy Inciarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Iván Chivite
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Duncan Short
- grid.476798.30000 0004 1771 726XViiV Healthcare, Brentford, Middlesex UK
| | - Emilio Salgado
- grid.410458.c0000 0000 9635 9413Medical Toxicology Unit, Emergency Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Martinez
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - José L. Blanco
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
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Adler Z, Fitzpatrick C, Broadwell N, Churchill D, Richardson D. Chemsex and antiretroviral prescribing in an HIV cohort in Brighton, UK. HIV Med 2022; 23:797-800. [PMID: 35048490 DOI: 10.1111/hiv.13239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chemsex has been reported among men who have sex with men (MSM) living with HIV. There have been concerns about potentially harmful drug-drug interactions between chemsex drugs and antiretroviral therapy (ritonavir and cobicistat). We aimed to describe the prevalence and patterns of chemsex users in our HIV clinic population and to evaluate antiretroviral prescribing among chemsex users. METHODS We undertook a cross-sectional study of patients attending our HIV clinic between January 2019 and December 2020. We collected data on patients who disclosed recent recreational drug use including chemsex in the previous 3 months. RESULTS In all, 2202/2501 (88%) patients were asked about recreational drug use and 514 (23%) disclosed recreational drug use. Eighty-two (4%) of these disclosed recent chemsex; 73 (89%) used crystal methamphetamine, 51 (62%) used gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), 55 (67%) reported poly-drug use and 63 (76%) reported injecting drug use. The chemsex users were all cis-male MSM and were significantly older (53 vs. 46 years, p < 0.0001), and more likely to have had previous syphilis (73% vs. 28%, p < 0.0001) than patients reporting non-chemsex drug use. All chemsex users were prescribed antiretrovirals and 74 (90%) had an undetectable HIV viral load; 31 (38%) patients were taking either ritonavir (N = 12) or cobicistat (N = 19) as part of their antiretroviral regimen and this was similar to other patients attending for HIV care [31/82 (38%) vs. 768/2419 (31%), p = 0.25]. CONCLUSIONS The prevalence of chemsex users among our HIV clinic attendants is 4%, and 38% of these were prescribed either ritonavir or cobicistat. Chemsex use should be a factor in antiretroviral therapy decision-making to avoid potential harm.
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Affiliation(s)
- Zoe Adler
- Unversity Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Daniel Richardson
- Unversity Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
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