More than-the-counter prescription drugs, meals dietary supplements, and other drugs may possibly interact with antiretroviral remedy (Art) in people today dwelling with HIV and be harmful, an industry-sponsored medical survey from Denmark reviews.
“Our research confirms that polypharmacy and remaining on a protease inhibitor-based routine raise the chance of opportunity drug-drug interactions (PDDIs) substantially and highlights the great importance of questioning men and women living with HIV (PLWH) about dietary complement intake,” the authors, led by Michaela Tinggaard, MD, Copenhagen University Medical center, write in HIV Medicine.
“Likely drug-drug interactions had been popular among the our review populace. Although the medical importance of the greater part of the identified PDDIs might be reduced, most of them had been avoidable by means of a change or discontinuation of the comedication, a transform in Art or by spacing drugs,” they insert.
Senior author Thomas Benfield, MD, DTMH, DMSc, a professor of infectious disorders at the College of Copenhagen, and colleagues gathered facts on prescription medication, more than-the-counter medication, and nutritional nutritional supplements from grown ups residing with HIV who acquired Artwork from two outpatient clinics.
The researchers estimated the prevalence of non-HIV comedications, and they used the College of Liverpool HIV Drug Interactions database to detect possible drug-drug interactions. They evaluated PDDIs and utilized logistic regression designs to investigate inbound links amongst PDDIs and appropriate variables.
The study included 337 men and women dwelling with HIV receiving Art. The median age was 53 yrs, 77% of them were male, and 96% were virally suppressed, with HIV-RNA viral load <50 copies/mL.
Overall, 26% of participants received five or more comedications, and 56% took dietary supplements.
In the medication lists of 52% of patients, the authors identified coadministration of drugs that required dose adjustment or monitoring.
4.5% of patients were taking drugs that should not be coadministered.
The researchers detected several factors that independently predicted PDDIs:
male sex (odds ratio (OR), 1.9 95% CI, 1.0 – 3.4)
being on a protease inhibitor (OR, 4.3 95% CI, 1.9 – 9.7)
receiving five or more comedications (OR, 3.3 95% CI, 1.5 – 7.2)
taking over-the-counter medications (OR, 1.9 95% CI, 1.1 – 3.3)
taking dietary supplements (OR, 2.0 95% CI, 1.2 – 3.3)
Comorbidities and OTC Medications Increase in Aging People with HIV
Indira Brar, MD, an infectious diseases senior staff physician and the medical director of HIV services at Henry Ford Health in Detroit, Michigan, called the study and important resource for educating providers and patients about over-the-counter drugs.
“The main strength of the study is that it includes a decent number of aging patients living with HIV, the age group in which we worry about drug interactions,” she told Medscape Medical News in an email.
“As individuals get more mature, they have greater comorbidities. As comorbidities raise, the number of prescription drugs boosts. As the variety of remedies increases, the drug interactions increase,” said Brar, who was not involved in the study. “Also, as people get more mature, they have a tendency to take extra around-the-counter medicine.”
Brar defined how drug-drug interactions can hurt people.
“Medicine extra to a affected individual who is by now on Art could lessen the degree of the Artwork and induce the patient to produce a drug-resistant HIV an infection,” she reported. “Or the Artwork the affected person is on can enhance the degrees of the new medications that have been extra, and that could have opportunity toxicity and aspect outcomes.
“Food stuff nutritional supplements, including multivitamins, calcium, and magnesium, are normally neglected since we think they are benign. But these medicine can bind our new antiretrovirals, the integrase inhibitors. They can lessen their amounts in the patient and lead to drug-resistant HIV infection.
“In our clinic, we usually inform our sufferers to make sure you contact us just before they consider any medication, so we can make confident there is no drug interaction,” Brar stated.
Nan Wang, PharmD, a clinical pharmacy specialist at University Hospitals Cleveland Healthcare Heart in Cleveland, Ohio, observed in an email that drug-drug interactions with ARTs are widespread.
“Being familiar with the prevalence of antiretroviral drug interactions in a patient populace can support establish specific prescription drugs that demand increased vigilance and can guideline our medical interventions,” mentioned Wang, who was not linked with the exploration.
Joseph Alvarnas, MD, a hematologist and oncologist at City of Hope In depth Most cancers Middle in Duarte, California, stated that this is “a methodologically seem and perfectly-designed analyze which is a well timed, important reminder that providers will need to consider carefully and comprehensively when caring for their patients residing with HIV.”
Alvarnas, who was not concerned in the examine, claimed that, with the prevalent availability of Art, HIV has become a chronic, manageable issue in an getting old population.
“Art agents, significantly the ritonavir-boosted protease inhibitors, increase the likelihood of patients obtaining a perhaps considerable drug-drug interaction with 1 of their persistent care remedies,” he included. “Even seemingly minimal-chance nutritional supplements these as multivitamins may final result in a detrimental influence on successful Artwork procedure of PLWH.”
“The important subsequent phase is that these findings are integrated meticulously into choice-assist units, electronic health and fitness report prescribing units, and pharmacy safety-look at methods to assure that we lower the threat of affected individual hurt,” Alvarnas recommended.
Benfield and several study co-authors report economic relationships with GlaxoSmithKline and other pharmaceutical providers. Other co-authors, as properly as Alvarnas, Brar, and Wang, report no suitable economic associations. The analyze was supported by GlaxoSmithKline.
HIV Med. Posted on the internet May perhaps 6, 2022. Summary
For additional news, stick to Medscape on Fb, Twitter, Instagram, YouTube, and LinkedIn