Identification of potential clinically significant drug interactions in HIV‐infected patients: a comprehensive therapeutic approach

• Published in: HIV medicine Vol. 16; no. 5; pp. 273 - 279
• Main Authors: Iniesta‐Navalón, C, Franco‐Miguel, JJ, Gascón‐Cánovas, JJ, Rentero‐Redondo, L
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2015
• Subjects: Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Antiretroviral agents; antiretroviral therapy; Benzodiazepines; Clinical significance; Comorbidity; Corticoids; Corticosteroids; Cross-Sectional Studies; Drug Administration Schedule; Drug interaction; Drug Interactions; Drug stores; Drug Therapy, Combination; Drugs; Female; Hepatitis B - drug therapy; Hepatitis C - drug therapy; HIV; HIV Fusion Inhibitors - administration & dosage; HIV Fusion Inhibitors - adverse effects; HIV Infections - drug therapy; HIV Integrase Inhibitors - administration & dosage; HIV Integrase Inhibitors - adverse effects; HIV Protease Inhibitors - administration & dosage; HIV Protease Inhibitors - adverse effects; Human immunodeficiency virus; Humans; Male; Middle Aged; Non-nucleoside reverse transcriptase inhibitors; outpatient; Patients; Phosphodiesterase 5 Inhibitors - administration & dosage; Phosphodiesterase 5 Inhibitors - adverse effects; Practice Patterns, Physicians; Prevalence; Protease; Protease inhibitors; Proteinase inhibitors; Proton pump inhibitors; Reverse Transcriptase Inhibitors - administration & dosage; Reverse Transcriptase Inhibitors - adverse effects; Risk Factors; RNA-directed DNA polymerase; Spain - epidemiology; Statistical analysis; Spain; risk factors; drug interactions; HIV; outpatient; antiretroviral therapy
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12205

Objectives The aim of the study was to determine the prevalence of potential clinically significant drug interactions (CSDIs) in HIV‐positive individuals and to identify associated risk factors. Methods A cross‐sectional study was conducted including all HIV‐infected out‐patients attending the Pharmacy Service of a regional reference hospital in Murcia, south‐eastern Spain. The complete treatment was screened for possible CSDIs using the Spanish College of Pharmacists' online software resource, bot. Additionally, the severity level of the CSDIs involving antiretroviral (ARV) drugs was compared with that established in the specific antiretroviral database InteraccionesHIV.com. Multivariate logistic regression was used to identify associated risk factors. Results Two hundred and sixty‐eight patients were included in the study. A total of 292 potential drug interactions were identified, of which 102 (34.9%) were CSDIs, of which 52.9% involved ARV drugs. Seven therapeutic drug classes were involved in 75% of CSDIs (protease inhibitors, benzodiazepines, nonsteroidal anti‐inflammatory drugs, nonnucleoside reverse transcriptase inhibitors, corticosteroids, antithrombotics and proton pump inhibitors). Factors independently associated with CSDIs were treatment with more than five drugs [odds ratio (OR) 15.1; 95% confidence interval (CI) 6.3–36.2], and treatment with a protease inhibitor (OR 5.3; 95% CI 2.4–11.74). Conclusions The findings of this study suggest that the prevalence of clinically relevant drug−drug interactions is high in HIV‐infected patients, and could represent a major health problem. Awareness, recognition and management of drug interactions are important in optimizing the pharmaceutical care of HIV‐infected patients and helping to prevent adverse events and/or loss of efficacy of the drugs administered.