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Tkachuk S, Ready E, Chan S, Hawkes J, Janzen Cheney T, Kapler J, Kreutzwiser D, Akagi L, Coombs M, Giguere P, Hughes C, Kelly D, Livingston S, Martel D, Naccarato M, Nhean S, Pozniak C, Ramsey T, Robinson L, Smith J, Swidrovich J, Symes J, Yoong D, Tseng A. Role of the pharmacist caring for people at risk of or living with HIV in Canada. Can Pharm J (Ott) 2024; 157:218-239. [PMID: 39310805 PMCID: PMC11412478 DOI: 10.1177/17151635241267350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 02/27/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Stacey Tkachuk
- Women and Children’s Health Centre of British Columbia, Provincial Health Services Authority, Vancouver, British Columbia
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
| | - Erin Ready
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
- St. Paul’s Hospital Ambulatory Pharmacy, Providence Health Care, Vancouver, British Columbia
| | - Shanna Chan
- Winnipeg Regional Health Authority Regional Pharmacy Program, Winnipeg, Manitoba
| | - Jennifer Hawkes
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
- University Hospital of Northern BC, Northern Health, Prince George, British Columbia
| | - Tracy Janzen Cheney
- Winnipeg Regional Health Authority Regional Pharmacy Program, Winnipeg, Manitoba
| | - Jeff Kapler
- Southern Alberta Clinic, Alberta Health Services, Calgary, Alberta
| | | | - Linda Akagi
- St. Paul’s Hospital Ambulatory Pharmacy, Providence Health Care, Vancouver, British Columbia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia
| | - Michael Coombs
- School of Pharmacy, Memorial University, St. John’s, Newfoundland
| | - Pierre Giguere
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario
- Ottawa Hospital Research Institute, Ottawa, Ontario
- School of Pharmaceutical Sciences, University of Ottawa, Ottawa, Ontario
| | - Christine Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Deborah Kelly
- School of Pharmacy, Memorial University, St. John’s, Newfoundland
| | - Sheri Livingston
- Tecumseh Byng Program, Windsor Regional Hospital, Windsor, Ontario
| | - Dominic Martel
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec
- Centre de recherche du CHUM (CRCHUM), Montreal, Quebec
| | | | - Salin Nhean
- Luminis Health Doctors Community Medical Center, Lanham, Maryland, USA
| | - Carley Pozniak
- Positive Living Program, Royal University Hospital, Saskatoon, Saskatchewan
| | - Tasha Ramsey
- Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Jodi Symes
- Pharmacy Department, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick
| | - Deborah Yoong
- St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario
| | - Alice Tseng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Toronto General Hospital, University Health Network, Toronto, Ontario
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2
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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3
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Marcatili M, Stefana A, Colmegna F, di Giacomo E, D'Amico E, Capuzzi E, Dakanalis A, Clerici M. Consultation psychiatry in COVID-19 patients: Lopinavir/ritonavir interactions with main psychiatric drugs. Psychiatry Clin Neurosci 2021; 75:145-146. [PMID: 33511703 PMCID: PMC8014835 DOI: 10.1111/pcn.13205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Matteo Marcatili
- Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabrizia Colmegna
- Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Ester di Giacomo
- Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Emiliano D'Amico
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- Psychiatric Department, San Gerardo Hospital, ASST Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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4
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HIV Infection and Related Mental Disorders. Brain Sci 2021; 11:brainsci11020248. [PMID: 33671125 PMCID: PMC7922767 DOI: 10.3390/brainsci11020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.
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5
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Borran M, Dashti-Khavidaki S, Khalili H. The need for an integrated pharmacological response to the treatment of HIV/AIDS and depression. Expert Opin Pharmacother 2021; 22:1179-1192. [PMID: 33586560 DOI: 10.1080/14656566.2021.1882419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The coexistence of depression and HIV infection affects more than 9 million people worldwide. A literature review revealed a large gap regarding the pharmacotherapy of depression among patients dually diagnosed with HIV and depression.Areas covered:In this review, the authors covered the various dimensions of deploying integrated pharmacological treatment of HIV/AIDS and depression. This topic was addressed in two ways; first, the direct results of integrated pharmacotherapy in syndemic patients; second, the indirect effects of the integrated model on other outcomes of HIV care.Expert opinion: An integrated pharmacological response to the treatment of HIV and depression can bring substantial benefits to HIV outcomes and reduce the burden of both diseases. The direct advantages regarding pharmacological response to the treatment of depression along with HIV care are improving adherence to antiretroviral therapy, optimizing pharmacotherapy, minimizing drug interaction, and prevention of additive adverse drug reactions. Furthermore, in some cases, medication can target both depression and other neuropsychiatric or somatic comorbidities among people living with HIV/AIDS. The integrated pharmacotherapy also has some potential indirect advantages on HIV care outcomes like minimizing loss of care, reducing ongoing HIV transmission, and improving the outcomes of both diseases.
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Affiliation(s)
- Mina Borran
- Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Simin Dashti-Khavidaki
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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6
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Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies. CNS Drugs 2021; 35:345-384. [PMID: 33866523 PMCID: PMC8053373 DOI: 10.1007/s40263-021-00811-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
As many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug-drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug-drug interactions resulting in additive or synergistic toxicity; (3) drug-disease interactions according to stage and severity of the disease; and (4) pharmacogenetic issues associated with polymorphisms of cytochrome P450 isoenzymes. In this review, we summarise the available literature on relevant drug interactions between psychotropic agents and COVID-19 therapies, providing practical clinical recommendations and potential management strategies according to severity of illness and clinical scenario.
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7
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Clinically Relevant Interactions between Atypical Antipsychotics and Anti-Infective Agents. Pharmaceuticals (Basel) 2020; 13:ph13120439. [PMID: 33276675 PMCID: PMC7761579 DOI: 10.3390/ph13120439] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
This is a comprehensive review of the literature on drug interactions (DIs) between atypical antipsychotics and anti-infective agents that focuses on those DIs with the potential to be clinically relevant and classifies them as pharmacokinetic (PK) or pharmacodynamic (PD) DIs. PubMed searches were conducted for each of the atypical antipsychotics and most commonly used anti-infective agents (13 atypical antipsychotics by 61 anti-infective agents/classes leading to 793 individual searches). Additional relevant articles were obtained from citations and from prior review articles written by the authors. Based on prior DI articles and our current understanding of PK and PD mechanism, we developed tables with practical recommendations for clinicians for: antibiotic DIs, antitubercular DIs, antifungal DIs, antiviral DIs, and other anti-infective DIs. Another table reflects that in clinical practice, DIs between atypical antipsychotics and anti-infective agents occur in patients also suffering an infection that may also influence the PK and PD mechanisms of both drugs (the atypical antipsychotic and the anti-infective agent(s)). These tables reflect the currently available literature and our current knowledge of the field and will need to be updated as new DI information becomes available.
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8
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Cattaneo D, Baldelli S, Resnati C, Giacomelli A, Meraviglia P, Minisci D, Astuti N, Ridolfo A, De Socio GV, Clementi E, Galli M, Gervasoni C. Evaluation of the concentrations of psychotropic drugs in HIV-infected versus HIV-negative patients: Potential implications for clinical practice. World J Biol Psychiatry 2020; 21:651-657. [PMID: 30058430 DOI: 10.1080/15622975.2018.1500032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: The management of psychiatric illness in HIV-infected patients is clinically challenging because of the risk of potential drug-drug interactions. Here, we aimed to measure the antidepressant and/or antipsychotic drug concentrations in HIV-infected patients during routine outpatient visits.Methods: Six hundred HIV-infected patients were screened during the first 15 months after the introduction of our outpatient polytherapy management service in a search for subjects treated with psychotropic drugs for at least 3 months. The distribution of psychotropic drug concentrations in HIV-infected patients was compared with that observed in a control group of HIV-negative patients monitored over the same period.Results: The search identified 82 HIV-infected patients concomitantly receiving antiretroviral and psychotropic drug treatment, 55% of whom had plasma psychotropic drug concentrations that were below minimum effective levels. The same result was found in only 26% of the samples taken from HIV-negative patients. These results were not affected by patients' gender, age, adherence to therapies or drug-drug interactions.Conclusions: A higher rate of sub-therapeutic antidepressant and/or antipsychotic drugs concentrations were found in HIV-infected patients. The creation of multidiscliplinary specialist teams may contribute to improving the management of such complex patients.
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Affiliation(s)
- Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) outpatient clinic, ASST Fatebenefratelli Sacco, Milan, Italy.,Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Sara Baldelli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Resnati
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Giacomelli
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola Meraviglia
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Minisci
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Noemi Astuti
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Annalisa Ridolfo
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giuseppe V De Socio
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Emilio Clementi
- Clinical Pharmacology Unit, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Department of Biomedical and Clinical Sciences, Sacco University Hospital, Università degli Studi di Milano, Milan, Italy.,E. Medea Scientific Institute, Bosisio Parini, Italy
| | - Massimo Galli
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cristina Gervasoni
- Gestione Ambulatoriale Politerapie (GAP) outpatient clinic, ASST Fatebenefratelli Sacco, Milan, Italy.,Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
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9
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Momenzadeh A, Shumway M, Dong BJ, Dilley J, Nye J, Mangurian C. Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital. Ann Pharmacother 2020; 55:452-458. [PMID: 32885983 DOI: 10.1177/1060028020954924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV infection is more prevalent among people with severe mental illness (SMI) than in the general population. People with SMI may lack access to recommended antiretroviral therapy (ART), and inpatient psychiatric admissions may be opportunities to ensure that individuals receive recommended treatment. OBJECTIVE To evaluate ART prescription patterns on an inpatient psychiatry service. METHODS In this retrospective, observational study, patient and admission characteristics and ART prescriptions were obtained for 248 HIV-positive inpatients between 2006 and 2012. Receipt of any ART, any recommended ART regimen, and ART with potentially harmful adverse events and drug interactions were examined. General estimating equation models were used to evaluate prescription patterns in relation to patient and admission characteristics. RESULTS ART was prescribed at 39% of discharges and increased by 51% during the study. Prescription was more common in admissions with an AIDS diagnosis and age greater than 29 years and less common in admissions associated with a psychotic diagnosis and shorter inpatient stays. When ART was prescribed, regimens were consistent with guideline recommendations 91% of the time. Prescription of potentially harmful regimens was limited. CONCLUSION AND RELEVANCE In an acute inpatient psychiatry setting in an urban HIV/AIDS epicenter, where psychotic disorders and brief and involuntary admissions were the norm, guideline-recommended ART regimens were prescribed at almost 60% of discharges by the end of the study. Future studies should explore interventions to increase ART for high-risk subpopulations with SMI, including younger individuals or those with brief inpatient psychiatry hospitalizations.
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Affiliation(s)
- Amanda Momenzadeh
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Martha Shumway
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Betty J Dong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - James Dilley
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jonathan Nye
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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10
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Truter I, Gaida R, Grobler C. OUTCOMES OF PEOPLE LIVING WITH HIV IN TWO PUBLIC-SECTOR PSYCHIATRIC FACILITIES IN THE EASTERN CAPE USING EFAVIRENZ-CONTAINING REGIMENS. Afr J Infect Dis 2020; 14:10-15. [PMID: 33884345 PMCID: PMC8047287 DOI: 10.21010/ajid.v14i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen. MATERIALS AND METHODS A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed. RESULTS A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen. CONCLUSION Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms.
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Affiliation(s)
- Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Razia Gaida
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Christoffel Grobler
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
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11
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Mohebbi N, Talebi A, Moghadamnia M, Nazari Taloki Z, Shakiba A. Drug Interactions of Psychiatric and COVID-19 Medications. Basic Clin Neurosci 2020; 11:185-200. [PMID: 32855778 PMCID: PMC7368108 DOI: 10.32598/bcn.11.covid19.2500.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. METHODS Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications. RESULTS There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce life-threatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system. CONCLUSION DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.
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Affiliation(s)
- Niayesh Mohebbi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs; Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Talebi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Moghadamnia
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Nazari Taloki
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alia Shakiba
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults. Brain Res 2019; 1723:146398. [PMID: 31442412 DOI: 10.1016/j.brainres.2019.146398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/21/2023]
Abstract
The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.
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13
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Drug-drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs. CNS Spectr 2019; 24:287-312. [PMID: 30295215 DOI: 10.1017/s109285291800113x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART), owing to a high prevalence of psychiatric illness within the population living with HIV, as well as a 7-fold increased risk of HIV infection among patients with psychiatric illness. While ART has been notoriously associated with a multitude of pharmacokinetic drug interactions involving the cytochrome P450 enzyme system, the magnitude and clinical impact of these interactions with psychotropics may range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression. This comprehensive review summarizes the currently available information regarding drug-drug interactions between antiretrovirals and pharmacologic agents utilized in the treatment of psychiatric disorders-antidepressants, stimulants, antipsychotics, anxiolytics, mood stabilizers, and treatments for opioid use disorder and alcohol use disorder-and provides recommendations for their management. Additionally, overlapping toxicities between antiretrovirals and the psychotropic classes are highlighted. Knowledge of the interaction and adverse effect potential of specific antiretrovirals and psychotropics will allow clinicians to make informed prescribing decisions to better promote the health and wellness of this high-risk population.
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14
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Abstract
Psychiatric and physical conditions often coexist, and there is robust evidence that associates the frequency of depression with single and multiple physical conditions. More than half of patients with depression may have at least one chronic physical condition. Therefore, antidepressants are often used in cotherapy with other medications for the management of both psychiatric and chronic physical illnesses. The risk of drug-drug interactions (DDIs) is augmented by complex polypharmacy regimens and extended periods of treatment required, of which possible outcomes range from tolerability issues to lack of efficacy and serious adverse events. Optimal patient outcomes may be achieved through drug selection with minimal potential for DDIs. Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of adults with major depressive disorder. Pharmacokinetic studies of desvenlafaxine have shown a simple metabolic profile unique among antidepressants. This review examines the DDI profiles of antidepressants, particularly desvenlafaxine, in relation to drugs of different therapeutic areas. The summary and comparison of information available is meant to help clinicians in making informed decisions when using desvenlafaxine in patients with depression and comorbid chronic conditions.
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Affiliation(s)
- Yvette Low
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Graca Lima
- Global Medical Affairs, Asia-Pacific Region, Pfizer, Hong Kong
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15
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Martínez-Banfi M, Vélez JI, Perea MV, García R, Puentes-Rozo PJ, Mebarak Chams M, Ladera V. Neuropsychological performance in patients with asymptomatic HIV-1 infection. AIDS Care 2018; 30:623-633. [PMID: 29411628 DOI: 10.1080/09540121.2018.1428728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Human immunodeficiency virus (HIV-1) infection and acquired immunodeficiency syndrome (AIDS) lead to neurocognitive disorders; however, there is still much knowledge to be gained regarding HIV-associated neurocognitive disorders. The purpose of this study was to assess the cognitive performance, instrumental activities of daily living, depression, and anxiety in patients with asymptomatic HIV-1 infections compared with seronegative participants without neurocognitive impairment. We studied a sample consisted of 60 patients with asymptomatic HIV-1 infections and 60 seronegative participants without neurocognitive impairment from the city of Barranquilla, Colombia, with a mean age of 36.07 years. A protocol of neuropsychological and psychopathological tests was applied to the participants. The group of patients with asymptomatic HIV infections significantly underperformed on tasks that assessed global cognitive screening, attention span, learning, phonemic verbal fluency, auditory-verbal comprehension, information processing speed, cognitive flexibility, and motor skills compared to the group of seronegative participants. No significant differences were found in memory, visual confrontation naming, vocabulary, inhibition, and instrumental activities of daily living. Additionally, the patients with asymptomatic HIV-1 infection had a higher anxiety index than the seronegative participants, but no significant difference was found in depression. A correlation was found between depression and anxiety. In conclusion, the patients with asymptomatic HIV-1 infection had lower cognitive performances than the seronegative participants in the cognitive functions mentioned above and more anxiety but still performed the instrumental activities of daily living.
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Affiliation(s)
- Martha Martínez-Banfi
- a Grupo de Neurociencias del Caribe , Universidad Simón Bolívar , Barranquilla , Colombia
| | - Jorge I Vélez
- b Departamento de Ingeniería Industrial , Universidad del Norte , Barranquilla , Colombia
| | - M Victoria Perea
- c Facultad de Psicología , Universidad de Salamanca , Salamanca , España
| | - Ricardo García
- c Facultad de Psicología , Universidad de Salamanca , Salamanca , España
| | - Pedro J Puentes-Rozo
- a Grupo de Neurociencias del Caribe , Universidad Simón Bolívar , Barranquilla , Colombia.,d Grupo de Neurociencias del Caribe, Universidad del Atlántico , Barranquilla , Colombia
| | | | - Valentina Ladera
- c Facultad de Psicología , Universidad de Salamanca , Salamanca , España
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Psychoactive drugs and HIV: are we sure to treat our patients adequately? AIDS 2018; 32:127-128. [PMID: 29210778 DOI: 10.1097/qad.0000000000001656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mills JC, Harman JS, Cook RL, Marlow NM, Harle CA, Duncan RP, Gaynes BN, Pence BW. Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression. AIDS 2017; 31:2515-2524. [PMID: 28832409 PMCID: PMC5680130 DOI: 10.1097/qad.0000000000001618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4 T cells/μl among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes. DESIGN Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems. METHODS We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4 T cells/μl. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects. RESULTS In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence interval = (1.12, 1.20)]. We observed an increase of 39 CD4T cells/μl after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models. CONCLUSION Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4 T cells/μl, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.
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Affiliation(s)
- Jon C Mills
- aDepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina bDepartment of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee cDepartment of Epidemiology and Medicine, University of Florida dDepartment of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida eDepartment of Health Policy and Management, Indiana University, Indianapolis, Indiana fDepartment of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
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Chary A, Nguyen NN, Maiton K, Holodniy M. A review of drug-drug interactions in older HIV-infected patients. Expert Rev Clin Pharmacol 2017; 10:1329-1352. [PMID: 28922979 DOI: 10.1080/17512433.2017.1377610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The number of older HIV-infected people is growing due to increasing life expectancies resulting from the use of antiretroviral therapy (ART). Both HIV and aging increase the risk of other comorbidities, such as cardiovascular disease, osteoporosis, and some malignancies, leading to greater challenges in managing HIV with other conditions. This results in complex medication regimens with the potential for significant drug-drug interactions and increased morbidity and mortality. Area covered: We review the metabolic pathways of ART and other medications used to treat medical co-morbidities, highlight potential areas of concern for drug-drug interactions, and where feasible, suggest alternative approaches for treating these conditions as suggested from national guidelines or articles published in the English language. Expert commentary: There is limited evidence-based data on ART drug interactions, pharmacokinetics and pharmacodynamics in the older HIV-infected population. Choosing and maintaining effective ART regimens for older adults requires consideration of side effect profile, individual comorbidities, interactions with concurrent prescriptions and non-prescription medications and supplements, dietary patterns with respect to dosing, pill burden and ease of dosing, cost and affordability, patient preferences, social situation, and ART resistance history. Practitioners must remain vigilant for potential drug interactions and intervene when there is a potential for harm.
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Affiliation(s)
- Aarthi Chary
- a Department of Medicine , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,b Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine , Stanford , CA , USA
| | - Nancy N Nguyen
- c Department of Pharmacy , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,d Department of Pharmacy Practice, Thomas J. Long School of Pharmacy & Health Sciences , University of the Pacific , Stockton , CA , USA
| | - Kimberly Maiton
- d Department of Pharmacy Practice, Thomas J. Long School of Pharmacy & Health Sciences , University of the Pacific , Stockton , CA , USA
| | - Mark Holodniy
- a Department of Medicine , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,b Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine , Stanford , CA , USA.,e Office of Public Health Surveillance & Research , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA
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Mills JC, Harman JS, Cook RL, Marlow NM, Harle CA, Duncan RP, Bengtson AM, Pence BW. Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS. J Affect Disord 2017; 215:179-186. [PMID: 28340444 PMCID: PMC5612416 DOI: 10.1016/j.jad.2017.03.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression. METHODS We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects. RESULTS In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity. LIMITATIONS Missing data was common but was addressed with inverse probability weights. CONCLUSIONS Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients' depression.
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Affiliation(s)
- Jon C Mills
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
| | - Jeffrey S Harman
- Florida State University, Department of Behavioral Sciences and Social Medicine, United States.
| | - Robert L Cook
- University of Florida, Department of Epidemiology and Medicine, United States.
| | - Nicole M Marlow
- University of Florida, Department of Health Services Research, Management and Policy, United States.
| | - Christopher A Harle
- Indiana University, Indianapolis, Department of Health Policy and Management, United States.
| | - R Paul Duncan
- University of Florida, Department of Health Services Research, Management and Policy, United States.
| | - Angela M Bengtson
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
| | - Brian W Pence
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
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Rado J. Neuropsychiatric Complications of Injection-Associated Diseases: HIV and Hepatitis C. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20161201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Smolders EJ, Berden FA, de Kanter CT, Kievit W, Drenth JP, Burger DM. The majority of hepatitis C patients treated with direct acting antivirals are at risk for relevant drug-drug interactions. United European Gastroenterol J 2016; 5:648-657. [PMID: 28815028 DOI: 10.1177/2050640616678151] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Direct-acting antivirals have improved treatment of chronic hepatitis C virus infection significantly. Direct-acting antivirals inhibit/induce and can also be substrates of drug-metabolising enzymes and transporters. This increases the risk for drug-drug interactions. OBJECTIVE The purpose of this study was to predict drug-drug interactions with co-medication used by hepatitis C virus-infected patients. METHODS We assembled a nationwide cohort of hepatitis C patients and collected cross-sectional data on co-medication use. We compiled a list of currently available direct-acting antiviral regimens and cross-checked for potential drug-drug interactions with used co-medication. RESULTS The cohort included 461 patients of which 77% used co-medication. We identified 260 drugs used as co-medication. Antidepressants (7.4%), proton pump inhibitors (7.1%) and benzodiazepines (7.1%) were most frequently used. Of the patients, 60% were at risk for a clinically relevant drug-drug interaction with at least one of the direct-acting antiviral regimens. Interactions were most common with paritaprevir/ritonavir/ombitasvir/dasabuvir and least interactions were predicted with grazoprevir/elbasvir. CONCLUSION Co-medication use is rich in frequency and diversity in chronic hepatitis C patients. The majority of patients are at risk for drug-drug interactions which may affect efficacy or toxicity of direct-acting antivirals or co-medication. The most recently introduced direct-acting antivirals are associated with a lower risk of drug-drug interactions.
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Affiliation(s)
- Elise J Smolders
- Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Floor Ac Berden
- Department of Gastroenterology and Hepatology, Radboud university medical center, Nijmegen, The Netherlands
| | - Clara Tmm de Kanter
- Department of Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Joost Ph Drenth
- Department of Gastroenterology and Hepatology, Radboud university medical center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
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Singer EJ, Thames AD. Neurobehavioral Manifestations of Human Immunodeficiency Virus/AIDS: Diagnosis and Treatment. Neurol Clin 2016; 34:33-53. [PMID: 26613994 DOI: 10.1016/j.ncl.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behavioral disorders are common in persons infected with human immunodeficiency virus (HIV). The differential includes preexisting psychiatric diseases, substance abuse, direct effects of HIV infection, opportunistic infection, and the adverse effects of medical therapies. Many patients have more than one contributing or comorbid problem to explain these behavioral changes. The differential should always include consideration of psychosocial, genetic, and medical causes of disease. Treatment strategies must take into account the coadministration of antiretroviral therapy and the specific neurologic problems common in patients infected with HIV.
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Affiliation(s)
- Elyse J Singer
- NeuroInfectious Diseases Program, UCLA National Neurological AIDS Bank, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room A129, Los Angeles, CA 90095, USA.
| | - April D Thames
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 740 Westwood Plaza, C8-746, Los Angeles, CA 90095, USA
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Elmore H, Lewin J, Bradley M, Sinkman A. Use of Granulocyte Colony-Stimulating Factor in a Neutropenic HIV-Infected Patient on Clozapine. PSYCHOSOMATICS 2016; 57:651-654. [PMID: 27720385 DOI: 10.1016/j.psym.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Hudson Elmore
- Department of Psychiatry, New York University School of Medicine, New York, NY.
| | - Justin Lewin
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Mark Bradley
- Department of Psychiatry, New York University School of Medicine, New York, NY; Department of Psychiatry, Veterans Affairs New York Harbor Healthcare System, New York, NY
| | - Arthur Sinkman
- Department of Psychiatry, New York University School of Medicine, New York, NY; Department of Psychiatry, Veterans Affairs New York Harbor Healthcare System, New York, NY
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Pala AN, Steca P, Bagrodia R, Helpman L, Colangeli V, Viale P, Wainberg M. Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients. Brain Behav Immun 2016; 56:105-13. [PMID: 26883521 PMCID: PMC5553322 DOI: 10.1016/j.bbi.2016.02.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/24/2016] [Accepted: 02/12/2016] [Indexed: 12/27/2022] Open
Abstract
Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes' difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients' lives and thus warrant further assessment and treatment.
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Affiliation(s)
- A. Norcini Pala
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA,Corresponding author at: HIV Center New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Dr, Unit 15, New York, NY 10032, USA. (A. Norcini Pala)
| | - P. Steca
- Milano-Bicocca University, Milan, Italy
| | - R. Bagrodia
- Teachers College, Columbia University, New York, NY, USA
| | - L. Helpman
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA
| | - V. Colangeli
- Institute of Infectious Diseases, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - P. Viale
- Institute of Infectious Diseases, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - M.L. Wainberg
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA
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Pasini M, Giuca G, Gatto R, Giuca M. Indagine sullo status parodontale di pazienti depressi in terapia con antidepressivi triciclici. DENTAL CADMOS 2016. [DOI: 10.1016/s0011-8524(16)30007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Inhibition of Efavirenz Metabolism by Sertraline and Nortriptyline and Their Effect on Efavirenz Plasma Concentrations. Antimicrob Agents Chemother 2015; 60:1022-8. [PMID: 26643342 DOI: 10.1128/aac.02129-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/22/2015] [Indexed: 11/20/2022] Open
Abstract
Between 22 and 45% of HIV-positive subjects are likely to report symptoms of depression. Considering this background, a potential pharmacokinetic interaction between the nonnucleoside reverse transcriptase inhibitor efavirenz (EFV) and two antidepressants, sertraline (SRT) and nortriptyline (NT), was studied. Rats were administered EFV alone or together with the antidepressants, and changes in the plasma levels and pharmacokinetic parameters of EFV were analyzed. Additional in vitro experiments with rat and human hepatic microsomes were carried out to evaluate the inhibitory effect of SRT and NT on EFV metabolism by determining the formation rate of the major EFV metabolite (8-OH-EFV). In vivo studies showed similar increases in the plasma levels of EFV when it was coadministered with SRT or NT. However, the studies using rat hepatic microsomes showed a more potent inhibitory effect of NT than of SRT on the metabolism of EFV, with values for the 50% inhibition constant (IC50) and inhibitory constant (Ki) for NT about 9-fold lower than those for SRT. An equation was deduced that explains the similar in vivo effects of SRT and NT in spite of the different in vitro performance data. Using human hepatic microsomes, the strongest inhibitory effect was observed with SRT. In summary, pharmacokinetic interactions between EFV, SRT, and NT, associated with the inhibition of hepatic metabolism of EFV, have been detected in rats. Both antidepressants also inhibit EFV metabolism in human hepatic microsomes, but additional in vivo studies in humans are required to evaluate the clinical implication of this interaction.
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[Consensus document on psychiatric and psychological aspect in adults and children with HIV infection]. Enferm Infecc Microbiol Clin 2015; 34:53.e1-53.e14. [PMID: 26409725 DOI: 10.1016/j.eimc.2015.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/29/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This consensus document is an update of psychiatric and psychological disorders guidelines in HIV-patientes, from the standpoint of care. METHODS This document has been approved by expert panel of SPNS, SEP, GESIDA and SEIP, after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented at conferences. The strength of recommendation and gradation of their evidence are based onthe GRADE system. RESULTS HIV Patient care should include psychological and psychiatric care which is necessary for early detection thereof. Should suicidal ideation, refer the patient to a psychiatric unit. Pharmacological treatment is recommended when there is comorbidity with moderate or severe depression. You should look for the etiology of neuropsychiatric disorder before using psychoactive drugs in HIV patients. The overall management of the health of HIV adolescents should include an assessment of mental health, environmental stressors and support systems. Training in the management of the patient both own emotions is critical to getting provide optimal care. CONCLUSIONS These new guidelines updated previous recommendations regarding psychiatric and psychological disorders, including the most common pathologies in adults and children.
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Blonk MI, Langemeijer CC, Colbers AP, Hoogtanders KE, van Schaik RH, Schouwenberg BJ, Burger DM. Pharmacokinetic drug-drug interaction study between raltegravir and citalopram. Antivir Ther 2015; 21:143-52. [PMID: 26375942 DOI: 10.3851/imp2993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression is the most common mental health disorder among HIV-infected patients. When treating HIV-infected patients with a selective serotonin reuptake inhibitor (SSRI), potential drug-drug interactions with antiretroviral agents have to be taken into account. We investigated the two-way pharmacokinetic drug-drug interaction and tolerability of concomitant administration of the SSRI citalopram and the HIV-1 integrase inhibitor raltegravir in healthy volunteers. METHODS An open-label, crossover, two-period trial was conducted in 24 healthy volunteers. Subjects received the following treatments: citalopram 20 mg once daily for 2 weeks followed by the combination with raltegravir 400 mg twice daily for 5 days and after a washout period raltegravir 400 mg twice daily for 5 days. Intensive steady-state pharmacokinetic blood sampling was performed. Geometric mean ratios (GMRs) of the combination versus the reference treatment and 90% CIs were calculated for the area under the plasma concentration-time curve (AUC). CYP2C19 genotyping was performed because it influences N-demethylation of citalopram to desmethylcitalopram. RESULTS A total of 22 healthy volunteers completed the trial. GMRs (90% CI) were 1.00 (0.98, 1.03) for citalopram AUC0-24 h, 0.99 (0.88, 1.12) for desmethylcitalopram AUC0-24 h and 0.77 (0.50, 1.19) for raltegravir AUC0-12 h. Raltegravir plasma concentration 12 h after intake (C12 h) did not change with concomitant use of citalopram. Within each CYP2C19 phenotype subgroup the citalopram metabolite-to-parent ratio, which is a measure for metabolic enzyme activity, was not influenced by concomitant raltegravir use. CONCLUSIONS Raltegravir does not influence the pharmacokinetics of citalopram and desmethylcitalopram. Citalopram did not change the pharmacokinetics of raltegravir in a clinically meaningful way. The combination was well tolerated and can be administered without dose adjustments. ClinicalTrials.gov NCT01978782.
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Affiliation(s)
- Maren I Blonk
- Department of Pharmacy, Radboud university medical center, Nijmegen, the Netherlands.
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Watkins CC, Treisman GJ. Cognitive impairment in patients with AIDS - prevalence and severity. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:35-47. [PMID: 25678819 PMCID: PMC4319681 DOI: 10.2147/hiv.s39665] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia.
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Affiliation(s)
- Crystal C Watkins
- The Memory Center in Neuropsychiatry, Sheppard Pratt Health System, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hughes CA, Tseng A, Cooper R. Managing drug interactions in HIV-infected adults with comorbid illness. CMAJ 2015; 187:36-43. [PMID: 25225224 PMCID: PMC4284166 DOI: 10.1503/cmaj.131626] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont.
| | - Alice Tseng
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont
| | - Ryan Cooper
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont
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HIV psychiatry in the era of combined antiretroviral therapy: top five issues. J Int AIDS Soc 2015; 18:20725. [PMID: 26548767 PMCID: PMC4637348 DOI: 10.7448/ias.18.1.20725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/08/2015] [Indexed: 12/04/2022] Open
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Phillips KD, Gunther ME. Sleep and HIV Disease. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated with the HIV illness. Evidences exist to support the importance of improving the identification of depressive symptoms and their adequate treatment. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality. By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, Cochrane Library), the review discusses the epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches, including psychosocial interventions, psychopharmacology as well as HIV-specific health psychology health service models.
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Gostner JM, Becker K, Kurz K, Fuchs D. Disturbed Amino Acid Metabolism in HIV: Association with Neuropsychiatric Symptoms. Front Psychiatry 2015; 6:97. [PMID: 26236243 PMCID: PMC4500866 DOI: 10.3389/fpsyt.2015.00097] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 06/17/2015] [Indexed: 12/31/2022] Open
Abstract
Blood levels of the amino acid phenylalanine, as well as of the tryptophan breakdown product kynurenine, are found to be elevated in human immunodeficiency virus type 1 (HIV-1)-infected patients. Both essential amino acids, tryptophan and phenylalanine, are important precursor molecules for neurotransmitter biosynthesis. Thus, dysregulated amino acid metabolism may be related to disease-associated neuropsychiatric symptoms, such as development of depression, fatigue, and cognitive impairment. Increased phenylalanine/tyrosine and kynurenine/tryptophan ratios are associated with immune activation in patients with HIV-1 infection and decrease upon effective antiretroviral therapy. Recent large-scale metabolic studies have confirmed the crucial involvement of tryptophan and phenylalanine metabolism in HIV-associated disease. Herein, we summarize the current status of the role of tryptophan and phenylalanine metabolism in HIV disease and discuss how inflammatory stress-associated dysregulation of amino acid metabolism may be part of the pathophysiology of common HIV-associated neuropsychiatric conditions.
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Affiliation(s)
- Johanna M Gostner
- Division of Medical Biochemistry, Biocenter, Medical University of Innsbruck , Innsbruck , Austria
| | - Kathrin Becker
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck , Innsbruck , Austria
| | - Katharina Kurz
- Department of Internal Medicine VI, Medical University of Innsbruck , Innsbruck , Austria
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck , Innsbruck , Austria
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35
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Pharmacokinetic interaction between nevirapine and nortriptyline in rats: inhibition of nevirapine metabolism by nortriptyline. Antimicrob Agents Chemother 2014; 58:7041-8. [PMID: 25224004 DOI: 10.1128/aac.03312-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One of the most frequent comorbidities of HIV infection is depression, with a lifetime prevalence of 22 to 45%. Therefore, it was decided to study a potential pharmacokinetic interaction between the nonnucleoside reverse transcriptase inhibitor nevirapine (NVP) and the tricyclic antidepressant nortriptyline (NT). NVP and NT were administered to rats either orally, intraduodenally, or intravenously, and the changes in plasma levels and pharmacokinetic parameters were analyzed. Experiments with rat and human hepatic microsomes were carried out to evaluate the inhibitory effects of NT on NVP metabolism. NVP plasma concentrations were significantly higher when this drug was coadministered with NT. The maximum plasma concentrations of NVP were increased 2 to 5 times and the total plasma clearance was decreased 7-fold in the presence of NT. However, statistically significant differences in the pharmacokinetic parameters of NT in the absence and presence of NVP were not found. In vitro studies with rat and human hepatic microsomes confirmed the inhibition of NVP hepatic metabolism by NT in a concentration-dependent way, with the inhibition being more intense in the case of rat microsomes. In conclusion, a pharmacokinetic interaction between NVP and NT was detected. This interaction was a consequence of the inhibition of hepatic metabolism of NVP by NT. In vivo human studies are required to evaluate the effects of this interaction on the pharmacokinetics of NVP before it can be taken into account for patients receiving NVP.
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36
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Eshun-Wilson I, Akena DH, Siegfried N, Obuku E, Stein DJ, Joska JA. Antidepressants for depression in adults with HIV infection. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd008525.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ingrid Eshun-Wilson
- University of Cape Town; Department of Family Medicine; Cape Town South Africa
| | - Dickens H Akena
- Makerere University, College of Health Sciences; Department of Psychiatry; KAMPALA Uganda
| | - Nandi Siegfried
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
- University of California, San Francisco; Department of Epidemiology and Biostatistics; San Francisco California USA
- School of Public Health and Family Medicine, University of Cape Town; Centre for Infectious Disease and Epidemiology Research (CIDER); Cape Town South Africa
| | - Ekwaro Obuku
- College of Health Sciences, Makerere University; Africa Centre for Systematic Reviews & Knowledge Translation; Kampala Uganda
| | - Dan J Stein
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
| | - John A. Joska
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
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37
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Rasmussen LD, Obel D, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, Obel N. Utilization of psychotropic drugs prescribed to persons with and without HIV infection: a Danish nationwide population-based cohort study. HIV Med 2014; 15:458-69. [DOI: 10.1111/hiv.12135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- LD Rasmussen
- Department of Infectious Diseases; Odense University Hospital; Odense Denmark
| | - D Obel
- Private Clinic of Child and Adolescent Psychiatry; Aarhus Denmark
| | - G Kronborg
- Department of Infectious Diseases; Copenhagen University Hospital; Hvidovre Denmark
| | - CS Larsen
- Department of Infectious Diseases; Aarhus University Hospital; Skejby Denmark
| | - C Pedersen
- Department of Infectious Diseases; Odense University Hospital; Odense Denmark
| | - J Gerstoft
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - N Obel
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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38
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Animal models for depression associated with HIV-1 infection. J Neuroimmune Pharmacol 2013; 9:195-208. [PMID: 24338381 DOI: 10.1007/s11481-013-9518-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 01/12/2023]
Abstract
Antiretroviral therapy has greatly extended the lifespan of people living with human immunodeficiency virus (PLHIV). As a result, the long-term effects of HIV infection, in particular those originating in the central nervous system (CNS), such as HIV associated depression, have gained importance. Animal models for HIV infection have proved very useful for understanding the disease and developing treatment strategies. However, HIV associated depression remains poorly understood and so far there is neither a fully satisfactory animal model, nor a pathophysiologically guided treatment for this condition. Here we review the neuroimmunological, neuroendocrine, neurotoxic and neurodegenerative basis for HIV depression and discuss strategies for employing HIV animal models, in particular humanized mice which are susceptible to HIV infection, for the study of HIV depression.
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Hayley S, Litteljohn D. Neuroplasticity and the next wave of antidepressant strategies. Front Cell Neurosci 2013; 7:218. [PMID: 24312008 PMCID: PMC3834236 DOI: 10.3389/fncel.2013.00218] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
Depression is a common chronic psychiatric disorder that is also often co-morbid with numerous neurological and immune diseases. Accumulating evidence indicates that disturbances of neuroplasticity occur with depression, including reductions of hippocampal neurogenesis and cortical synaptogenesis. Improper trophic support stemming from stressor-induced reductions of growth factors, most notably brain derived neurotrophic factor (BDNF), likely drives such aberrant neuroplasticity. We posit that psychological and immune stressors can interact upon a vulnerable genetic background to promote depression by disturbing BDNF and neuroplastic processes. Furthermore, the chronic and commonly relapsing nature of depression is suggested to stem from "faulty wiring" of emotional circuits driven by neuroplastic aberrations. The present review considers depression in such terms and attempts to integrate the available evidence indicating that the efficacy of current and "next wave" antidepressant treatments, whether used alone or in combination, is at least partially tied to their ability to modulate neuroplasticity. We particularly focus on the N-methyl-D-aspartate (NMDA) antagonist, ketamine, which already has well documented rapid antidepressant effects, and the trophic cytokine, erythropoietin (EPO), which we propose as a potential adjunctive antidepressant agent.
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Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University Ottawa, ON, Canada
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Corona G, Vignozzi L, Sforza A, Maggi M. Risks and benefits of late onset hypogonadism treatment: an expert opinion. World J Mens Health 2013; 31:103-25. [PMID: 24044106 PMCID: PMC3770846 DOI: 10.5534/wjmh.2013.31.2.103] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/02/2013] [Accepted: 06/10/2013] [Indexed: 12/13/2022] Open
Abstract
Late-onset hypogonadism (LOH) is a syndromic condition that has a well-recognized association with sexual and reproductive failure. LOH is frequently associated with chronic conditions including cardiovascular diseases (CVD), obesity, osteoporosis, HIV infection, renal failure, and obstructive pulmonary diseases. Despite this evidence, in patients with these conditions, LOH is still only rarely investigated and testosterone replacement therapy (TRT) rarely considered. In this paper, we critically reviewed the available evidence on LOH treatment focusing on possible risks and benefits. Medical therapy of LOH should be individualized depending on the etiology of the disease and the patient's expectations. The fear of prostate cancer and the risk of erythrocytosis probably represent the main limitations of TRT in aging men. However, TRT in healthy older men in near physiological doses does not appear to incur serious adverse events, although regular monitoring of prostate-specific antigen and hematocrit levels is required. Available evidence also suggests that TRT might ameliorate central obesity and glycometabolic control in patients with metabolic syndrome and type 2 diabetes. In addition, TRT has been associated with an increase in bone mineral density in men with osteoporosis, with an improvement in lean body mass in subjects with human immunodeficiency virus infection or chronic obstructive pulmonary disease, as well as with peripheral oxygenation in patients with chronic kidney diseases. Despite this evidence, however, it should be recognized that the results of these trials were heterogeneous and limited by small sample sizes. Hence, further research is required regarding the long-term benefits and adverse effects of TRT in LOH.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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