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Zhang Y, Johnson M, Joshi S, Yazdani P, Zhan J, Wen B, Bainbridge V, Gartland M, Lataillade M. Open-label, drug-drug interaction study between the HIV-1 maturation inhibitor GSK3640254 and a metabolic probe cocktail in healthy participants. Br J Clin Pharmacol 2023; 89:2236-2245. [PMID: 36822839 DOI: 10.1111/bcp.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
AIMS GSK3640254 (GSK'254) is an HIV-1 maturation inhibitor with pharmacokinetics (PK) supporting once-daily dosing. GSK'254 will be co-administered with cytochrome P450 enzyme substrates and drug transporters, including other antiretrovirals, in people living with HIV-1 (PLWH). METHODS In this open-label study, healthy participants received a single dose of a cocktail of eight cytochrome P450 and transporter probe substrates on Day 1, followed by a 10-day washout before receiving GSK'254 200 mg once daily from Days 11 to 20 and a single dose of cocktail + GSK'254 200 mg on Day 21. Geometric least-squares mean ratios and 90% confidence intervals were obtained using linear mixed-effects models. Adverse events (AEs) were monitored. RESULTS Of 20 participants enrolled, 19 completed the study. Plasma concentrations of all cocktail substrates were generally similar with or without GSK'254 co-administration. All 90% confidence intervals around geometric least-squares mean ratios for cocktail substrate PK parameters indicated no to weak interactions. Steady-state plasma GSK'254 concentrations were achieved by Day 17 and maintained through Day 21. Nine participants (45%) reported 17 AEs; most (88%) were grade 1. Two grade 2 treatment-related AEs (maculopapular rash [leading to withdrawal] and papular rash) were reported during GSK'254 administration alone. CONCLUSIONS Co-administration of GSK'254 with a metabolic probe cocktail in healthy participants indicated very low risk of clinically relevant effect on PK of any substrates or associated metabolites. No new safety/tolerability concerns were identified. These results support ongoing phase IIb and planned phase III studies of GSK'254 in people living with HIV-1.
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Affiliation(s)
| | | | | | | | | | - Bo Wen
- GSK, Collegeville, Pennsylvania, USA
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2
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de Oliveira Costa J, Lau S, Medland N, Gibbons S, Schaffer AL, Pearson S. Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia. Br J Clin Pharmacol 2023; 89:1541-1553. [PMID: 36434744 PMCID: PMC10953433 DOI: 10.1111/bcp.15614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS We quantified concomitant medicine use and occurrence of potential drug-drug interactions in people living with HIV in Australia who are treated with antiretroviral therapy (ART). METHODS In this cohort study using dispensing claims of a 10% random sample of Australians, we identified 2230 people dispensed ART between January 2018 and December 2019 (mean age 49.0 years, standard deviation 12.0 years, 88% male). We examined concomitant medicine use by identifying nontopical medicines dispensed within 90-days of any antiretroviral medicine dispensing during a 12-month follow-up period. For every antiretroviral and nonantiretroviral pair, we identified and classified possible drug-drug interactions using the University of Liverpool HIV drug interactions database. RESULTS A total of 1728 (78%) people were dispensed at least 1 and 633 (28%) 5 or more unique medicines in addition to ART in a 12-month period; systemic anti-infectives and medicines acting on the nervous system were the most common (68% and 56%, respectively). Among comedicated people, 1637 (95%) had at least 1 medicine combination classified as weak interactions, 558 (32%) interactions requiring close monitoring/dose adjustment and 94 (5%) that should not be coadministered. Contraindication or interactions requiring close monitoring/dose adjustment were more common among people receiving protease inhibitors (50-73% across different antiretrovirals), non-nucleoside reverse transcriptase inhibitors (35-64%), people using single-tablet combinations containing elvitegravir (30-46%) and those using tenofovir disoproxil (26-30%). CONCLUSION Concomitant medicine use is widespread among people living with HIV in Australia. Despite a relatively low prevalence of contraindicated medicines, almost a third received medicines that require close monitoring or dose adjustment.
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Affiliation(s)
- Juliana de Oliveira Costa
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
| | - Stella Lau
- Postgraduate Program in Health Data Science, Centre for Big Data Research in Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
| | | | - Sara Gibbons
- Department of PharmacologyUniversity of LiverpoolLiverpoolUK
| | - Andrea L. Schaffer
- Medicines Intelligence Research ProgramSchool of Population Health – Faculty of Medicine and Health/UNSW SydneySydneyAustralia
| | - Sallie‐Anne Pearson
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and HealthUNSW SydneySydneyAustralia
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3
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Salle R, Mayslich C, Grange PA, Leducq V, Ollagnier G, Heller U, Saule J, Martinet P, Robert JL, Benhaddou N, Fouere S, Dupin N. Specific detection of Treponema pallidum in clinical samples: validation of a qPCR assay combining two genomic targets. Sex Transm Infect 2023; 99:91-96. [PMID: 35459752 DOI: 10.1136/sextrans-2021-055364] [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: 11/17/2021] [Accepted: 04/01/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We evaluated a real-time quantitative PCR (qPCR) for detection of the Treponema pallidum (TP) genome in clinical samples through simultaneous detection of two genomic targets. METHODS We performed qPCR with TaqMan technology using two TP genes, polA and tpp47, as targets, with an internal positive control. The qPCR assay was compared with syphilis diagnosis based on a combination of clinical examination, serological results and inhouse nested PCR (nPCR). Samples were analysed at the National Reference Center for STIs at Cochin Hospital in Paris. RESULTS In total, from October 2010 to December 2016, 320 documented clinical samples (mucosal and cutaneous swabs) were collected from patients with or without syphilis attending STI centres in France. The qPCR had an overall sensitivity of 89% (95% CI 85.1% to 92.1%), a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 88% (95% CI 84.3% to 91.5%). The agreement between qPCR and nPCR results was 94% (κ=0.88, 95% CI 0.83 to 0.93). Calibration of the qPCR assay, by cloning both the polA and tpp47 genes, defined the detection threshold as 1 copy/µL of DNA elution. CONCLUSIONS We validated a new qPCR for detecting the TP genome in clinical samples with excellent sensitivity and specificity. The cloning of polA and tpp47 genes for calibration would be interesting in the evaluation of bacterial loads in samples.
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Affiliation(s)
- Romain Salle
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris, Paris, France.,Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Constance Mayslich
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris, Paris, France
| | - Philippe Alain Grange
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris, Paris, France.,Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Valentin Leducq
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Department of Virology, F-75013, Paris, France
| | - Guillaume Ollagnier
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris, Paris, France.,Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Ugo Heller
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon, APHP, Clichy, France
| | - Julie Saule
- CeGIDD-Conseil Départemental 13 Joliette, Marseille, France
| | - Pervenche Martinet
- CeGIDD-Conseil Départemental 13 Joliette; CeGIDD-Conseil Départemental 13 Saint Adrien, Marseille, France
| | - Jean-Luc Robert
- CeGIDD-Conseil Départemental 13 d'Aix, Aix-en-Provence, France
| | - Nadjet Benhaddou
- Service de Bactériologie, APHP, CNR Streptocoques, Paris, France
| | - Sebastien Fouere
- Groupe Hospitalier Saint-Louis, Lariboisière, Fernand-Widal, CeGIDD, APHP, Paris, France
| | - Nicolas Dupin
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris, Paris, France .,Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
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4
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Poojar B, Shenoy K A, Kamath A, Ramapuram J, Rao SB. Evaluation of health literacy and medication regimen complexity index among patients with human immunodeficiency virus infection: A single-Centre, prospective, cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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5
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Danjuma MI, Adegboye OA, Aboughalia A, Soliman N, Almishal R, Abdul H, Mohamed MFH, Elshafie MN, AlKhal A, Elzouki A, Al-Saud A, Chaponda M, Bidmos MA. Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis. Ther Adv Drug Saf 2022; 13:20420986221080795. [PMID: 36052397 PMCID: PMC9425890 DOI: 10.1177/20420986221080795] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper–Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using I2 and τ2 statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4–77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25–42%) (I2 = 100%, τ2 = 0.9170, p < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27–63%) (I2 = 100%, τ2 = 1.0886, p < 0.01) than Europe (29%, 95% CI: 20–40%) (I2 = 100%, τ2 = 0.7944, p < 0.01). Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071 Plain Language Summary Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors? Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America’s compared with European cohorts of PLWH. Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.
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Affiliation(s)
- Mohammed I Danjuma
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Oyelola A Adegboye
- Evolution Equations Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | | | - Nada Soliman
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ruba Almishal
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Haseeb Abdul
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Mohamed Nabil Elshafie
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulatif AlKhal
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Centre for Disease Control, Hamad Medical Corporation, Doha, Qatar
| | - Abdelnaser Elzouki
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Arwa Al-Saud
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mas Chaponda
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Centre for Disease Control, Hamad Medical Corporation, Doha, Qatar
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Danjuma MIM, Khan S, Wahbeh F, Naseralallah LM, Jumbo UE, Elzouki A. What is polypharmacy in people living with HIV/AIDS? A systematic review. AIDS Res Ther 2022; 19:37. [PMID: 35918746 PMCID: PMC9344688 DOI: 10.1186/s12981-022-00461-4] [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: 12/23/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as "minor" (N = 3); "major" (N = 29); "severe" (N = 2); "excessive" (N = 1); and "higher" (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.
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Affiliation(s)
- Mohammed Ibn-Mas'ud Danjuma
- Division of General Internal Medicine, Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
- Weill Cornell College of Medicine, New York and Doha, Qatar.
| | - Safah Khan
- Weill Cornell College of Medicine, New York and Doha, Qatar
| | - Farah Wahbeh
- Weill Cornell College of Medicine, New York and Doha, Qatar
| | - Lina Mohammad Naseralallah
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Unwam E Jumbo
- Division of General Internal Medicine, Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdelnaser Elzouki
- Division of General Internal Medicine, Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Weill Cornell College of Medicine, New York and Doha, Qatar
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7
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Rubin LH, Neijna AG, Shi Q, Hoover DR, Tamraz B, Anastos K, Edmonds A, Fischl MA, Gustafson D, Maki PM, Merenstein D, Sheth AN, Springer G, Vance D, Weber KM, Sharma A. Degree of Polypharmacy and Cognitive Function in Older Women with HIV. AIDS Res Hum Retroviruses 2022; 38:571-579. [PMID: 35357949 PMCID: PMC9297323 DOI: 10.1089/aid.2021.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0-4), moderate (5-9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (p = .007) and processing speed (p = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ava G. Neijna
- Department of Neurology and Baltimore, Maryland, USA
| | - Qiuhu Shi
- New York Medical College, Valhalla, New York, USA
| | | | - Bani Tamraz
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | | | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Deborah Gustafson
- Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, New York, USA
| | - Pauline M. Maki
- Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Vance
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Kathleen M. Weber
- Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Anjali Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
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8
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Murray MM, Lin J, Buros Stein A, Wilcox ML, Cottreau J, Postelnick M, Palella FJ. Relationship of polypharmacy to HIV RNA suppression in people aged ≥ 50 years living with HIV. HIV Med 2021; 22:742-749. [PMID: 34077632 DOI: 10.1111/hiv.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) aged ≥ 50 years face unique challenges regarding their medication therapies, especially antiretroviral therapy (ART). Use of ARTs, along with medications for comorbidities, may lead to adverse events, drug-drug interactions (DDIs) and poor adherence. The objective of this study was to identify the number of medications above which PLWH aged ≥ 50 years are less likely to be virally suppressed and to describe other associated patient-specific risk factors. METHODS This was a cross-sectional study of PLWH aged ≥ 50 years, prescribed ART, and seen at least once in the Northwestern Infectious Disease Center between 1 June 2013 and 31 May 2015. Variables concerning medication use and comorbidities were collected. The primary outcome was the presence of an undetectable plasma HIV RNA level (viral load). RESULTS Among the 621 included patients, there was a higher percentage taking ≤ 15 medications with an undetectable plasma HIV RNA (n = 453; 80.6%) vs. patients taking > 15 medications (n = 40; 67.8%; P = 0.03). Taking > 15 medications [odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.96], pulmonary disease (OR 0.54; 95% CI 0.3-0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22-0.68) decreased the odds of having an undetectable plasma HIV RNA. CONCLUSIONS PLWH taking > 15 medications were less likely to have an undetectable HIV RNA. Further studies are needed to evaluate the impact of overall medication economic burden on clinical outcomes among PLWH ≥ 50 years of age.
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Affiliation(s)
- M M Murray
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Lin
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA
| | - A Buros Stein
- Midwestern University, Office of Research and Sponsored Programs, Glendale, AZ, USA
| | - M L Wilcox
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Cottreau
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - M Postelnick
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - F J Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Sok P, Mgbere O, Pompeii L, Essien EJ. Evaluation of the Sociodemographic, Behavioral and Clinical Influences on Complete Antiretroviral Therapy Adherence Among HIV-Infected Adults Receiving Medical Care in Houston, Texas. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:539-555. [PMID: 34040451 PMCID: PMC8140896 DOI: 10.2147/hiv.s303791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022]
Abstract
Introduction Few studies have estimated complete antiretroviral therapy (ART) adherence following HIV infection since the advent of the new ART guidelines in 2012. This study determined the prevalence and influence of sociodemographic, behavioral, and clinical factors on complete ART adherence among people living with HIV (PLWH) receiving medical care in Houston/Harris County, Texas. Methods Data from the Houston Medical Monitoring Project survey collected from 2009 to 2014 among 1073 participants were used in this study. The primary outcome evaluated was combined adherence, defined as complete, partial, and incomplete combined adherence based on three ART adherence types—dose, schedule, and instruction adherence. The duration living since initial HIV diagnosis was classified as <5, 5–10 and >10 years. Rao–Scott Chi-square test and multivariable proportional-odds cumulative logit regression models were employed to identify the sociodemographic, behavioral, and clinical characteristics of complete combined adherence among the three groups of PLWH living with HIV infection. Results More than one-half (54.4%) of PLWH had complete, 37.4% had partial, and 8.3% had incomplete combined adherence. Among these PLWH, 52.2% had been infected with HIV for >10 years, and 26.5% and 21.4% were infected for <5 years and 5–10 years, respectively. PLWH who were diagnosed <5 and 5–10 years were two times (aOR=1.71, 95% CI=1.13–2.57; aOR=1.69, 95% CI=1.10–2.59; respectively) more likely to experience complete combined adherence than those with >10 years of infection. Multiple sociodemographic, behavioral, and clinical characteristics were significantly associated with complete adherence and varied by the duration of HIV infection. Conclusion Measures of adherence should include all adherence types (dose, schedule, instruction), as utilizing a single adherence type will overestimate adherence level in PLWH receiving medical care. Intervention efforts to maintain adherence should target recently infected PLWH, while those aimed at improving adherence should focus on longer infected PLWH.
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Affiliation(s)
- Pagna Sok
- The University of Texas School of Public Health, Texas Medical Center, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Texas Medical Center, Houston, TX, USA
| | - Osaro Mgbere
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, USA.,Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Lisa Pompeii
- The University of Texas School of Public Health, Texas Medical Center, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Texas Medical Center, Houston, TX, USA
| | - Ekere James Essien
- The University of Texas School of Public Health, Texas Medical Center, Houston, TX, USA.,Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA.,Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
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10
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Serrano Giménez R, Gallardo Anciano J, Robustillo Cortés MA, Blanco Ramos JR, Gutiérrez Pizarraya A, Morillo Verdugo R. Beliefs and attitudes about deprescription in older HIV-infected patients: ICARD Project. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:18-27. [PMID: 33191724 PMCID: PMC7876903 DOI: 10.37201/req/084.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE HIV population is aging at an earlier age than those uninfected, requiring more non-HIV medications to treat noncommunicable diseases. In the context of chronic HIV infection, the next therapeutic change would be the polymedication control. This paper has the purpose of explore the attitudes of older people living with HIV toward deprescribing. METHODS This was an observational, prospective and multicenter study conducted from March-April, 2018. People living with HIV (PLWH) on highly active antiretroviral therapy and older than 65 years were included. In addition to demographic and pharmacotherapeutic data, attitudes regarding deprescribing were collected through the "Revised Patients' Attitudes Towards Deprescribing Questionnaire". RESULTS A total of 42 patients were included in this study. Regarding their attitudes in relation to deprescription, there were three statements with the most consensuses. The first ("I have a good understanding of the reasons I was prescribed each of my medicines") had 91.9% consensus. The second and third questions showed 89.2% consensus in both cases; "Overall, I am satisfied with my current medicines" and "I like to be involved in making decisions about my medicines with my doctors". CONCLUSIONS This study is the first to explore the beliefs and attitudes of older PLWH in relation to deprescription process. There are positive attitudes regarding medication knowledge but there also is a percentage of patients who had a negative opinion regarding deprescription. We must study and go deeper in our knowledge of techniques that could help us to better understand their preferences, in order to establish effective and successful deprescription strategies.
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Affiliation(s)
- R Serrano Giménez
- Reyes Serrano Giménez, Pharmacy Department, Valme University Hospital, Sevilla (Spain). Bellavista Avenue, no number. Postal Code: 41014.
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11
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Yeşilbağ Z, Şengül Eİ, Şenoğlu S, Aydın ÖA, Karaosmanoğlu HK. Co-medications and Drug-Drug Interactions in People Living with HIV in Turkey in the Era of Integrase Inhibitors. Curr HIV Res 2020; 18:415-425. [PMID: 32787762 DOI: 10.2174/1574885515666200812215140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors. METHODS A retrospective observational study was conducted between January 2016-August 2019. Patients' characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. RESULTS Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. CONCLUSION Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.
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Affiliation(s)
- Zuhal Yeşilbağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emine İlay Şengül
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Şenoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Özlem Altuntaş Aydın
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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12
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Xia H, Gao L, Gong X, Zaongo SD, Zhang T, Wu H, Ma P, Huang X. The Challenge of Potential Drug-Drug Interactions Among People Living With HIV on Antiretroviral Therapy: A Cross-Sectional Study in Selected Provinces in China. Front Pharmacol 2020; 11:800. [PMID: 32536872 PMCID: PMC7266979 DOI: 10.3389/fphar.2020.00800] [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: 02/19/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Potential drug–drug interactions (DDIs) are a significant therapeutic threat among human immunodeficiency virus (HIV)-positive individuals on antiretroviral (ARV) medications. DDIs involving ARV drugs in mainland China are unknown and insufficiently described. Herein, we investigated the prevalence and frequencies of potential ARV DDIs in Chinese people living with HIV (PLWH), then we assessed the risk factors associated with potential DDIs. Methods This study was conducted with HIV-positive adults undergoing ARV medications from multiple centers across China. The latest prescription of each participant was evaluated for potential DDIs using the Liverpool HIV drug interaction database. Multivariable logistic regressions were used to evaluate the factors associated with DDIs. Results Among 600 PLWH recruited, at least one non-HIV co-medication was observed in 511 (85.2%) individuals. A total of 2566 DDIs were identified, of which 11 (0.43%) and 311 (12.89%) were of contraindicated (red-flags) and dosage/timing adjustment required (orange-flags), respectively. Multivariate regression analysis revealed a higher risk of clinically significant DDIs (red- and orange-flagged comedication) associated with: the use of boosted protease inhibitors (p < 0.0001), boosted integrase strand transfer inhibitors (p < 0.0001), and non-nucleoside reverse transcriptase inhibitors-based ARV regimen (p < 0.0001); or the use of antiinfectives for systemic use (p < 0.0001), cardiovascular system drugs (p < 0.0001), nervous system drugs (p < 0.0001), fungal infection (p = 0.0071), and Herpes simplex virus infection (p = 0.0231). Conclusions Potential DDIs and inappropriate medications constitute a burden for people living with HIV in China. The knowledge of DDIs patterns and the scan for DDIs is crucial. Indeed, they can help to prevent drug-related adverse outcomes in such immunodeficient population.
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Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Liying Gao
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaowen Gong
- Department of Biostatistics, Tianjin Medical University, Tianjin, China
| | - Silvere D Zaongo
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China.,International School of Medicine, Tianjin Medical University, Tianjin, China
| | - Tong Zhang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ping Ma
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaojie Huang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Abstract
OBJECTIVE To characterize comorbid disease and medication burden among women living with HIV (WLWH) in British Columbia (BC), Canada. DESIGN We examined baseline data from 267 WLWH and 276 HIV-negative women, aged at least 19 years, enrolled in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort. METHODS Self-reported demographic, medical condition, medication, vitamin, and substance exposure data were collected at baseline CARMA study visits. We considered conditions with appropriate concomitant medications to be 'treated'. Wilcoxon rank-sum and Fisher's exact tests compared continuous and categorical variables between WLWH and HIV-negative women. Number of diagnoses, prescribed medications (excluding HIV/antiretrovirals), vitamins, and prevalence of depression/anxiety/panic disorder were compared using negative binomial and logistic regressions for continuous and binary variables, respectively. RESULTS WLWH were younger [median, interquartile range (IQR) 39.9, 33.6-46.9 vs. 43.6, 31.8-54.6 years; P = 0.01], attained lower education (40.5 vs. 69.6% college/university; P < 0.001), and more often currently smoked tobacco (47.9 vs. 31.9%; P < 0.001) or had income less than $15 000/year (49.0 vs. 43.1%; P < 0.001). Although younger, and despite omitting HIV infection, WLWH had a greater number of diagnoses (incidence rate ratio, 95% confidence interval 1.58, 1.38-1.81; P < 0.001), and more depression/anxiety/panic disorder vs. controls (odds ratio, 95% CI 1.86, 1.22-2.83; P = 0.004). Our model predicts that with mean BMI (26.3), WLWH and HIV-negative peers would have two comorbid diagnoses by age 30 and 60, respectively. CONCLUSIONS WLWH living in BC have more comorbid illness earlier in life than their HIV-negative peers, and have very high rates of depression/anxiety/panic disorder. Addressing mental health and comorbid conditions is essential to improving health outcomes among WLWH.
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14
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Mama Djima M, Ekouevi DK, Gregoire JP, Tchounga B, Coffie PA, Tran VT, Touré FY, Moisan J. Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study. PLoS One 2019; 14:e0221335. [PMID: 31525222 PMCID: PMC6746366 DOI: 10.1371/journal.pone.0221335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire. Methods A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. Results A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. Conclusion Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.
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Affiliation(s)
- Mariam Mama Djima
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Institut Pasteur de Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- * E-mail:
| | - Didier Koumavi Ekouevi
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm U 1219, ISPED, Université Victor Segalen, Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Jean-Pierre Gregoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | | | | | | | | | - Jocelyne Moisan
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
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Falutz J, Kirkland S, Guaraldi G. Geriatric Syndromes in People Living with HIV Associated with Ageing and Increasing Comorbidities: Implications for Neurocognitive Complications of HIV Infection. Curr Top Behav Neurosci 2019; 50:301-327. [PMID: 31907879 DOI: 10.1007/7854_2019_119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Long-term survival of treated people living with HIV (PLWH) currently approaches that of the general population. The average age of PLWH is currently in the mid-50s in resource-rich countries and is predicted that over 40% of PLWH will be older than 60 within a decade. Similar trends have been confirmed in all communities of PLWH with access to antiretroviral therapies. However, the positive impact on survival has been challenged by several developments. Ageing PLWH have clinical features similar to the general population about 5-10 years older. In addition to the earlier occurrence of common age-related conditions common geriatric syndromes have also impacted this population prematurely. These are often difficult to evaluate and manage conditions usually of multifactorial aetiology. They include polypharmacy, frailty, impaired mobility and falls, sarcopenia, sensory impairment, and increasingly, non-dementing cognitive decline. Cognitive decline is of particular concern to PLWH and their care providers. In the general geriatric population cognitive impairment increases with age and occurs in all populations with a prevalence of over 25% in people over 80. Effective treatments are lacking and therefore minimizing risk factors plays an important role in maintaining healthspan. In the general population geriatric syndromes may increase the risk of cognitive decline. The corollary is that decreasing the risk of their development may limit cognitive impairment. Whether a similar status holds in PLWH is uncertain. This chapter will address the question of whether common geriatric syndromes in PLWH contribute to cognitive impairment. Common risk factors may provide clues to limit or delay cognitive decline.
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Affiliation(s)
- Julian Falutz
- McGill University Health Centre, Montreal, QC, Canada.
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Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol 2018; 11:1171-1181. [PMID: 30444968 DOI: 10.1080/17512433.2018.1549484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. Areas covered: This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. Expert commentary: Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
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Affiliation(s)
- Giovanni Guaraldi
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Ines Pintassilgo
- c Internal Medicine Department , Hospital Garcia de Orta , Almada , Portugal
| | - Jovana Milic
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy.,d Clinical and Experimental Medicine PhD Program , University of Modena and Reggio Emilia , Modena , Italy
| | - Cristina Mussini
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
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Radtke KK, Bacchetti P, Anastos K, Merenstein D, Crystal H, Karim R, Weber KM, Edmonds A, Sheth AN, Fischl MA, Vance D, Greenblatt RM, Rubin LH. Use of Nonantiretroviral Medications That May Impact Neurocognition: Patterns and Predictors in a Large, Long-Term HIV Cohort Study. J Acquir Immune Defic Syndr 2018; 78:202-208. [PMID: 29762344 PMCID: PMC5962283 DOI: 10.1097/qai.0000000000001658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neurocognitive impairment is a frequent and often disabling comorbidity of HIV infection. In addition to antiretroviral therapies, individuals with HIV infection may commonly use nonantiretroviral medications that are known to cause neurocognitive adverse effects (NC-AE). The contribution of NC-AE to neurocognitive impairment is rarely considered in the context of HIV and could explain part of the variability in neurocognitive performance among individuals with HIV. SETTING Women's Interagency HIV Study, a prospective, multisite, observational study of US women with and without HIV. METHODS After a literature review, 79 medications (excluding statins) with NC-AE were identified and reported by Women's Interagency HIV Study participants. We examined factors associated with self-reported use of these medications over a 10-year period. Generalized estimating equations for binary outcomes were used to assess sociodemographic, behavioral, and clinical characteristics associated with NC-AE medication use. RESULTS Three thousand three hundred women (71% with HIV) and data from ∼42,000 visits were studied. HIV infection was associated with NC-AE medication use (odds ratio = 1.52; 95% confidence interval: 1.35 to 1.71). After adjustment for HIV infection status, other predictors of NC-AE medication use included having health insurance, elevated depressive symptoms, prior clinical AIDS, noninjection recreational drug use, and an annual household income of <$12,000 (Ps < 0.004). NC-AE medication use was less likely among women who drank 1-7 or 8-12 alcoholic drinks/week (vs. abstaining) (P < 0.04). CONCLUSIONS HIV infection was associated with NC-AE medication use, which may influence determinations of HIV-associated neurocognitive impairment. Providers should consider the impact of NC-AE medications when evaluating patients with HIV and concurrent neurocognitive symptoms.
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Affiliation(s)
- Kendra K Radtke
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Howard Crystal
- Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NYDepartment of Neurology, Johns Hopkins University, Baltimore, MD
| | - Roksana Karim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen M Weber
- Cook County Health and Hospital System, Hektoen Institute of Medicine, Chicago, IL
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Margaret A Fischl
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL
| | - David Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Ruth M Greenblatt
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
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Adam GP, Di M, Cu-Uvin S, Halladay C, Smith BT, Iyer S, Trikalinos TA. Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map. Syst Rev 2018; 7:25. [PMID: 29391059 PMCID: PMC5796491 DOI: 10.1186/s13643-018-0684-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While in its early years the HIV epidemic affected primarily the male and the young, nowadays, the population living with HIV/AIDS is approximately 24% women, and its age composition has shifted towards older ages. Many of the older women who live with HIV/AIDS also live with the medical and social conditions that accompany aging. This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Forty was chosen as an operational age cutoff to identify premenopausal women who are less likely to bear children, as well as peri- and postmenopausal women. METHODS We conducted a literature search after discussions with a diverse panel of content experts and other stakeholders and developed an evidence map that identified 890 citations that address questions having to do with programs and barriers to engaging with programs, as well as the role of insurance and comorbidities, and have enrolled older women who live with HIV/AIDS. RESULTS Of these, only 37 (4%) reported results of interest for women over 40 who live with HIV/AIDS, or examined interactions between gender and older age that would allow predictions in this subgroup. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40. CONCLUSION The evidence base that is directly applicable to women over 40 who live with HIV/AIDS in the USA is limited, and the research need is broad. We propose research prioritization strategies for this population.
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Affiliation(s)
- Gaelen P Adam
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Mengyang Di
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Susan Cu-Uvin
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.,Department of Ob-Gyn and Medicine, Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Halladay
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Bryant T Smith
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Suchitra Iyer
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Thomas A Trikalinos
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS 2018; 32:35-48. [PMID: 29135584 PMCID: PMC5732638 DOI: 10.1097/qad.0000000000001685] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. DESIGN Cross-sectional. METHODS Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression. RESULTS Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (versus sexual health clinic) and benzodiazepine use. Seventeen participants (3%) took at least one concomitant medication contraindicated with their antiretroviral therapy, and 237 (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant medication use was significantly associated with sleep disturbance and myalgia, and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant medication adherence, independently associated with requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health and at least 1 bed day for illness in the previous 12 months. CONCLUSION In a resource-rich setting with universal healthcare access, the majority of this sample took a concomitant medication. Over half had at least one of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic interaction. Concomitant medication use was associated with several adverse clinical outcomes.
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McNicholl IR, Gandhi M, Hare CB, Greene M, Pierluissi E. A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older HIV-Positive Patients. Pharmacotherapy 2017; 37:1498-1506. [PMID: 29023938 DOI: 10.1002/phar.2043] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions. DESIGN Prospective randomized interventional trial. SETTING Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients. DATA SOURCE A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months. PATIENTS After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. MEASUREMENTS AND MAIN RESULTS Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm3 . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. CONCLUSIONS Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention.
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Affiliation(s)
- Ian R McNicholl
- HIV Medical Affairs, Gilead Sciences, Inc., Foster City, California
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - C Bradley Hare
- Infectious Diseases, Kaiser Permanente, San Francisco, California
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Edgar Pierluissi
- Division of Geriatrics and Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California
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21
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Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment-Clinical Points of View and Practical Considerations. Front Pharmacol 2017; 8:831. [PMID: 29218008 PMCID: PMC5703840 DOI: 10.3389/fphar.2017.00831] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/31/2017] [Indexed: 01/19/2023] Open
Abstract
HIV infection is responsible for one the most devastating human pandemics. The advent of antiretroviral therapy has changed the course of the pandemic and saved millions of lives. Complex therapeutic regimens have been introduced since 1996 and have contributed to the transformation of HIV infection into a treatable chronic diseases. New types of potent antiretrovirals and their combinations, including “once daily” treatment, have simplified the regimens and diminished side effects. Nevertheless the adherence to antiretroviral therapy remains unsatisfactory and varies between 27 and 80% across different population in various studies, compared with the required level of 95%. The lack of adherence to antiretroviral therapy is a multi-factorial and dynamic process which raises considerable difficulties for long-term follow-up. Current solutions to this problem are complex. These should be applied by a multidisciplinary team and should take into account key features related to both the individual and social factors as well as to the population to whom it belongs (children, teenagers, elderly, marginalized population like drug users, incarcerated patients, sex workers, etc.). Importantly, adherence should continue to be monitored even in patients known to be compliant. In case of subsequent failure the team should identify the reasons for non-adherence and apply the appropriate methods. Where usual methods have no chance of success, a coordinated package of services also known as “harm reduction” can be offered in order to reduce the risks of transmission. The current article analyses the concept of adherence to antiretroviral therapy, the shortcomings of this medication and the methods that can be applied in practice to increase adherence. Emphasis is placed on the analysis of groups at high risk for HIV infection that currently represent the spearhead with which the HIV pandemic is spreading.
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Affiliation(s)
- Simona A Iacob
- Infectious Diseases Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Diana G Iacob
- The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Gheorghita Jugulete
- Infectious Diseases Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
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22
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Smith JM, Flexner C. The challenge of polypharmacy in an aging population and implications for future antiretroviral therapy development. AIDS 2017; 31 Suppl 2:S173-S184. [PMID: 28471948 DOI: 10.1097/qad.0000000000001401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: It is estimated that by 2030 nearly three-quarters of persons living with HIV will be 50 years and older. The aging HIV population presents a new clinical concern for HIV providers: adverse effects from polypharmacy. An aging population means more comorbidities and potentially more drug-drug interactions for providers to manage. This review discusses major comorbidities including cardiovascular disease, anticoagulation, hypertension, diabetes mellitus and malignancy and considerations for drug-interactions with antiretrovirals.
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23
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Ripa M, Chiappetta S, Tambussi G. Immunosenescence and hurdles in the clinical management of older HIV-patients. Virulence 2017; 8:508-528. [PMID: 28276994 DOI: 10.1080/21505594.2017.1292197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
People living with HIV (PLWH) who are treated with effective highly active antiretroviral therapy (HAART) have a similar life expectancy to the general population. Moreover, an increasing proportion of new HIV diagnoses are made in people older than 50 y. The number of older HIV-infected patients is thus constantly growing and it is expected that by 2030 around 70% of PLWH will be more than 50 y old. On the other hand, HIV infection itself is responsible for accelerated immunosenescence, a progressive decline of immune system function in both the adaptive and the innate arm, which impairs the ability of an individual to respond to infections and to give rise to long-term immunity; furthermore, older patients tend to have a worse immunological response to HAART. In this review we focus on the pathogenesis of HIV-induced immunosenescence and on the clinical management of older HIV-infected patients.
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Affiliation(s)
- Marco Ripa
- a Department of Infectious and Tropical Diseases , Ospedale San Raffaele , Milan , Italy
| | - Stefania Chiappetta
- a Department of Infectious and Tropical Diseases , Ospedale San Raffaele , Milan , Italy
| | - Giuseppe Tambussi
- a Department of Infectious and Tropical Diseases , Ospedale San Raffaele , Milan , Italy
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24
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Gimeno-Gracia M, Crusells-Canales MJ, Armesto-Gómez FJ, Compaired-Turlán V, Rabanaque-Hernández MJ. Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population. Clin Interv Aging 2016; 11:1149-57. [PMID: 27616883 PMCID: PMC5008447 DOI: 10.2147/cia.s108072] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication. Objectives To quantify polypharmacy and profile types of non-antiretroviral drugs collected at community pharmacies in 2014 by HIV-positive individuals on antiretroviral therapy and to compare these findings with those of the general population. Methods HIV-positive patients (n=199) were compared with a group of patients from the general population (n=8,172), aged between 50 and 64 years. The factors compared were prevalence of polypharmacy (≥5 comedications with cumulative defined daily dose [DDD] per drug over 180), percentage of patients who collected each therapeutic class of drug, and median duration for each drug class (based on DDD). Results were stratified by sex. Results Polypharmacy was more common in HIV-positive males than in the male general population (8.9% vs 4.4%, P=0.010). Polypharmacy was also higher in HIV-positive females than in the female general population (11.3% vs 3.4%, P=0.002). Percentage of HIV-positive patients receiving analgesics, anti-infectives, gastrointestinal drugs, central nervous system (CNS) agents, and respiratory drugs was higher than in the general population, with significant differences between male populations. No differences were observed in proportion of patients receiving cardiovascular drugs. The estimated number of treatment days (median DDDs) were higher in HIV-positive males than in males from the general population for anti-infectives (32.2 vs 20.0, P<0.001) and CNS agents (238.7 vs 120.0, P=0.002). A higher percentage of HIV-positive males than males from the general population received sulfonamides (17.1% vs 1.5%, P<0.001), macrolides (37.1% vs 24.9%, P=0.020), and quinolones (34.3% vs 21.2%, P=0.009). Conclusion Polypharmacy is more common in HIV-positive older males and females than in similarly aged members of the general population. HIV-positive patients received more CNS drugs and anti-infectives, specifically sulfonamides, macrolides, and quinolones, but there were no differences in the percentage of patients receiving cardiovascular drugs. It is essential to investigate nonantiretroviral therapy medication use in the HIV-positive population to ensure these patients receive appropriate management.
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Affiliation(s)
- Mercedes Gimeno-Gracia
- Pharmacy Department, Lozano Blesa University Clinical Hospital, Aragon Institute for Health Research
| | - María José Crusells-Canales
- Department of Infectious Diseases, Aragon Institute for Health Research, Lozano Blesa University Clinical Hospital
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Abstract
Dolutegravir (DTG) is a second-generation integrase strand transfer inhibitor (INSTI), which has now been licensed to be used in different countries including the UK. Earlier studies have demonstrated that DTG when used with nucleoside backbone in treatment-naïve and - experienced patients has been well tolerated and demonstrated virological suppression comparable to other INSTIs and superiority against other first-line agents, including efavirenz and boosted protease inhibitors. Like other INSTIs, DTG uses separate metabolic pathways compared to other antiretrovirals and is a minor substrate for CYP-450. It does not appear to have a significant interaction with drugs, which uses the CYP-450 system. Nonetheless, it uses renal solute transporters that may potentially inhibit the transport of other drugs and can have an effect on the elimination of other drugs. However, the impact of this mechanism appears to be very minimal and insignificant clinically. The side effect profiles of DTG are similar to raltegravir and have been found to be well tolerated. DTG has a long plasma half-life and is suitable for once daily use without the need for a boosting agent. DTG has all the potential to be used as a first-line drug in combination with other nucleoside backbones, especially in the form of a single tablet in combination with abacavir and lamivudine. The purpose of this review article is to present the summary of the available key information about the clinical usefulness of DTG in the treatment of HIV infection.
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Affiliation(s)
- Huda Taha
- Integrated Sexual Health Service Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Archik Das
- School of Medicine, Birmingham University, Birmingham, UK
| | - Satyajit Das
- Integrated Sexual Health Service Coventry and Warwickshire Partnership NHS Trust, Coventry, UK ; Coventry University, Coventry, UK
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