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. 2022 Jul 1;36(8):1105-1115.
doi: 10.1097/QAD.0000000000003226. Epub 2022 Mar 11.

Evolving patterns of antiretroviral drug interactions in people with HIV in British Columbia, Canada

Katherine J Lepik  1   2 , Lu Wang  1 , Marianne Harris  1   3 , Taylor McLinden  1 , Sidhant Guliani  1 , Linda Akagi  1   2 , Junine Toy  1   2 , Paul Sereda  1 , Viviane D Lima  1   3 , Julio S G Montaner  1   3 , Rolando Barrios  1   3
Affiliations

Evolving patterns of antiretroviral drug interactions in people with HIV in British Columbia, Canada

Katherine J Lepik et al. AIDS. .

Abstract

Objectives: To characterize the annual prevalence of antiretroviral/nonantiretroviral drug interactions in relation to antiretroviral therapy (ART)-prescribing patterns, and to describe drug interaction-related ART changes.

Design/methods: This cohort study included ART-treated adults in British Columbia, Canada between 01 January 2010 and 31 December 2016. Medication dispensing records were abstracted from a population-based, linked administrative-health dataset and used to identify antiretroviral-comedication drug interactions ('caution'/'avoid' drug interactions in HIV-focused drug interaction checkers). We identified temporal trends in annual drug interaction prevalence and quantified the association between taking higher drug interaction-risk ART and receiving nonrecommended antiretroviral-comedication combinations using Poisson regression models, modified for binary outcomes and correlated data. Clinician-reported, drug interaction-related ART changes and associated adverse events were abstracted from an HIV drug treatment registry and summarized descriptively.

Results: Among 8571 ART-treated adults who received nonantiretroviral comedications, prevalence of having any drug interaction or receiving nonrecommended drug combination(s) significantly declined from 85 to 71% and 5.6 to 3.2%, respectively, between 2010 and 2016 ( P < 0.001). This paralleled a shift from higher drug interaction-risk ART (e.g. ritonavir/cobicistat-boosted protease inhibitors) to lower drug interaction-risk ART (e.g. unboosted integrase inhibitors). Risk of receiving a nonrecommended antiretroviral-comedication combination was greater for persons taking higher vs. lower drug interaction-risk ART [adjusted risk ratio (aRR) 3.12, 95% confidence interval (CI) 2.24-4.35]. Boosted antiretroviral-inhaled corticosteroid drug interactions accounted for the most commonly dispensed, nonrecommended drug combinations, and the most commonly reported drug interaction-related adverse events (adrenal insufficiency).

Conclusion: The prevalence of antiretroviral-comedication drug interactions is declining as ART shifts towards antiretrovirals with lower drug interaction potential but nonrecommended drug combinations remain a concern. Healthcare providers should screen for drug interactions whenever drugs are prescribed or dispensed.

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References

    1. Montaner JS, Lima VD, Harrigan PR, Lourenco L, Yip B, Nosyk B, et al. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the ‘HIV Treatment as Prevention’ experience in a Canadian setting . PLoS One 2014; 9:e87872.
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. HPTN 052 Study Team. Antiretroviral therapy for the prevention of HIV-1 transmission . N Engl J Med 2016; 375:830–839.
    1. Tseng A, Seet J, Phillips EJ. The evolution of three decades of antiretroviral therapy: challenges, triumphs and the promise of the future . Br J Clin Pharmacol 2015; 79:182–194.
    1. Back D, Marzolini C. The challenge of HIV treatment in an era of polypharmacy . J Int AIDS Soc 2020; 23:e25449.
    1. Gibbons S, Marzolini C, Moss C, McAllister K, Chiong J, Back D, et al.Changes in drug interaction profiles for first-line HIV therapy over the 20 years of the Liverpool Drug Interaction website [Abstract 5] . In: 20th International Workshop on Clinical Pharmacology of HIV, Hepatitis, and Other Antiviral Drugs . Noordwikj, the Netherlands. 14–16 May 2019.

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