Prevalence of drug-drug interactions has decreased in the INSTI era but is still substantial
Presenter: An-Ting Peng, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, Republic of China
Lower prevalence of potential drug-drug interactions among people living with HIV in the era of integrase inhibitor-based antiretroviral therapy. Presented July 24, 2023.
The prevalence of potential drug-drug interactions has declined in the era of integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART), although it remains substantial.
Aging people living with HIV are at a higher risk for potential drug-drug interactions due to an increased burden of comorbidities and comedications. Unrecognized drug-drug interactions can lead to toxicities or underdosing, compromising drug efficacy. In an effort to better understand the potential for drug-drug interactions in the era of INSTI-based ART, researchers led by An-Ting Peng, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, Republic of China, performed a cross-sectional study of 1,007 consecutive people living with HIV who had been on ART for at least 3 months at two hospitals for HIV care in Taiwan.
Patients’ demographics, HIV treatment history, and the presence of comorbidities were recorded from electronic data capture tools, and all prescriptions, including ART and non-ART treatments, were collected in the 3 months prior to the date of review and screened for red-label and amber-label potential drug-drug interactions using the University of Liverpool HIV drug interactions database. This database classifies drug pairs as having contraindicated drug interactions (red) if they may lead to serious side effects or lack of therapeutic effect, potentially clinically significant drug interactions (amber) if they can be managed by modification of the dosage or close monitoring, interactions of weak clinical significance (yellow), or no interaction expected (green).
Current ART consisted of boosted INSTI-based therapy in 15.0% of the overall cohort, which doubled to 30.1% among those with drug-drug interactions. Polypharmacy was present in 28.6% of the overall study population and 47.3% of those with drug-drug interactions. The most common concomitant non-ART medications were in the alimentary tract and metabolism categories: 24.8% of the overall cohort and 59.6% of the patients with drug-drug interactions.
The prevalence of potential drug-drug interactions increased with age, from 10% among those younger than 40 years, to 19% among those age 40 to 50 years, and 26% among those 50 years and older (P < .001 vs < 40 years of age). Seven (0.7%) of the patients had red-label potential drug-drug interactions and 163 (16.2%) had amber-label potential drug-drug interactions, both of which were lower than those observed in historical controls (1.4%–7.0% with red-label and 18.0%–52.0% with amber-label potential drug-drug interactions). The most common combinations responsible for amber-label interactions were antacids with INSTI or rilpivirine (n = 52), metformin with dolutegravir, bictegravir, or elvitegravir (n = 37), and a benzodiazepine with cobicistat (n = 33). The most common combination responsible for a red-label interaction was domperidone with cobicistat (n = 4).
On multivariable analysis, boosted INSTI-based treatment (P < .001), number of comedications (P = .045), medications in the alimentary tract and metabolism categories (P < .001), and prescriptions for antineoplastic and immunomodulating agents (P = .033) were associated with potential drug-drug interactions.
“HIV care providers should be vigilant in screening and managing the potential drug-drug interactions, especially in older people living with HIV, those with increased number of comedications, and those who are taking booster-containing ART or medications from specific categories,” the authors concluded.
Dr. Peng has nothing to disclose.