Abstract
Background: Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors.
Methods: A retrospective observational study was conducted between January 2016-August 2019. Patients’ characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. Results: Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. Conclusion: Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.Keywords: Co-medication, drug-drug interactions, elvitegravir/cobicistat, HIV, inhaled drugs, integrase inhibitors.
Graphical Abstract
[http://dx.doi.org/10.1056/NEJM199803263381301] [PMID: 9516219]
[http://dx.doi.org/10.1093/jac/dkr248] [PMID: 21680580]
[http://dx.doi.org/10.3851/IMP2076] [PMID: 22358155]
[http://dx.doi.org/10.1016/S0140-6736(10)60676-9] [PMID: 20609987]
[http://dx.doi.org/10.1093/jac/dkv259] [PMID: 26286575]
[http://dx.doi.org/10.1086/590150] [PMID: 18627268]
[PMID: 23818773]
[http://dx.doi.org/10.1371/journal.pone.0203895] [PMID: 30240419]
[http://dx.doi.org/10.1080/17512433.2019.1627200] [PMID: 31155978]
[http://dx.doi.org/10.1093/cid/cir627] [PMID: 21998278]
[http://dx.doi.org/10.1007/s11904-010-0041-9] [PMID: 20425560]
[http://dx.doi.org/10.1111/j.1532-5415.2012.03948.x] [PMID: 22568508]
[http://dx.doi.org/10.1007/s40266-013-0093-9] [PMID: 23740523]
[http://dx.doi.org/10.1002/jia2.25449] [PMID: 32011104]
[http://dx.doi.org/10.1111/jgs.12695] [PMID: 24576251]
[http://dx.doi.org/10.1001/jama.2013.2963] [PMID: 23549585]
[http://dx.doi.org/10.1371/journal.pone.0203890] [PMID: 30204807]
[http://dx.doi.org/10.1093/jac/dkp152] [PMID: 19398457]
[http://dx.doi.org/10.1080/15284336.2017.1404690] [PMID: 29179644]
[http://dx.doi.org/10.1592/phco.27.10.1379] [PMID: 17896893]
[http://dx.doi.org/10.1371/journal.pone.0016800] [PMID: 21373194]
[http://dx.doi.org/10.1345/aph.1P576] [PMID: 21386025]
[http://dx.doi.org/10.1007/s11908-011-0229-1] [PMID: 22125049]
[http://dx.doi.org/10.1086/652149] [PMID: 20380564]
[http://dx.doi.org/10.1111/hiv.12205] [PMID: 25523089]
[http://dx.doi.org/10.1111/j.1365-2710.2003.00541.x] [PMID: 15068400]
[http://dx.doi.org/10.1177/0956462412472428] [PMID: 23562967]
[PMID: 18350204]
[http://dx.doi.org/10.1089/aid.2011.0247] [PMID: 22250979]
[http://dx.doi.org/10.1001/jama.300.5.530] [PMID: 18677025]
[http://dx.doi.org/10.1086/528863] [PMID: 18444871]
[http://dx.doi.org/10.1097/00002030-200402200-00012] [PMID: 15090798]
[http://dx.doi.org/10.1093/jac/dks346] [PMID: 22915459]
[http://dx.doi.org/10.1186/1742-6405-8-18] [PMID: 21575228]
[http://dx.doi.org/10.1097/01.qai.0000219769.89679.ec] [PMID: 16652030]
[http://dx.doi.org/10.1371/journal.pone.0087338] [PMID: 24489899]
[http://dx.doi.org/10.1177/1060028016685115] [PMID: 28367698]
[http://dx.doi.org/10.2146/ajhp170613] [PMID: 29903710]
[http://dx.doi.org/10.1517/17425255.2014.993606] [PMID: 25557864]
[http://dx.doi.org/10.1592/phco.31.5.480] [PMID: 21923429]
[http://dx.doi.org/10.1001/jama.2018.8431] [PMID: 30043070]
[http://dx.doi.org/10.1016/S1473-3099(15)00056-0] [PMID: 26070969]
[http://dx.doi.org/10.1093/cid/cir626] [PMID: 21998280]
[http://dx.doi.org/10.1086/523577] [PMID: 18190322]
[http://dx.doi.org/10.2174/157016209789973691] [PMID: 19929794]
[PMID: 28847251]
[http://dx.doi.org/10.1179/1528433614Z.0000000012] [PMID: 25978302]
[http://dx.doi.org/10.3851/IMP1540] [PMID: 20516560]
[PMID: 28741582]
[http://dx.doi.org/10.1136/bmjopen-2017-019985] [PMID: 29903786]
[PMID: 28453027]
[http://dx.doi.org/10.1111/hiv.12801] [PMID: 31532898]
[http://dx.doi.org/10.3906/sag-1807-295] [PMID: 30761883]
[http://dx.doi.org/10.1007/s11908-009-0036-0] [PMID: 19366568]
[http://dx.doi.org/10.1310/hct1102-100] [PMID: 20542846]
[http://dx.doi.org/10.1136/bmjopen-2012-002378] [PMID: 23645921]
[http://dx.doi.org/10.1089/jwh.2012.3972] [PMID: 24206025]
[http://dx.doi.org/10.1016/j.cpr.2005.02.001] [PMID: 15914265]
[http://dx.doi.org/10.1097/00002030-200401001-00008] [PMID: 15075498]
[http://dx.doi.org/10.1080/13548506.2011.554645] [PMID: 21749242]
[http://dx.doi.org/10.3390/ijerph16152667] [PMID: 31349674]
[http://dx.doi.org/10.1007/s11606-013-2449-6] [PMID: 23605401]
[http://dx.doi.org/10.1097/QAD.0000000000001685] [PMID: 29135584]
[http://dx.doi.org/10.1177/1060028013504075] [PMID: 24285760]
[http://dx.doi.org/10.1097/QAI.0000000000001653] [PMID: 29767640]
[http://dx.doi.org/10.1016/j.jiac.2020.04.003] [PMID: 32354599]
[PMID: 29959841]
[http://dx.doi.org/10.1093/ofid/ofz051] [PMID: 30949521]