Clinically Significant Drug-Drug Interaction in a Large Antiretroviral Treatment Centre in Lagos, Nigeria

Abstract


 Background: An important cause of treatment failure to antiretroviral therapy (ART) is the potential interaction between the antiretroviral (ARV) drugs and co-prescribed drugs used concomitantly for the treatment of opportunistic infections and co-morbid ailments in HIV-infected patients.
 Objectives: The study evaluated potential clinically significant drug interactions (CSDIs) occurring between recommended ART regimens and their co-prescribed non-antiretroviral drugs (CPD)
 Method: This study was carried out in a large HIV treatment centre (APIN clinic) in a Nigerian teaching hospital, in Lagos Nigeria, caring for over 20,000 registered patients. Electronic Medical Records (EMR) of 500 patients who received treatment between 2005 and 2015, were selected using systematic random sampling, reviewed retrospectively, and evaluated for potential CSDIs using Liverpool HIV Pharmacology Database and other similar databases. 
 Results: Majority of patients, 421 (84%) were at risk of CSDIs, of which 410, (82%) were moderate and frequently involved co-trimoxazole + zidovudine (or stavudine) /lamivudine (386, 77.2%) and NNRTIs or PIs + artemisinin-based combination therapies (ACTs) [296, 59.2%]. Age (p=0.131), sex (p=0.316) and baseline CD4+ cell counts (p>0.05) were not significantly associated with CSDIs. The interactions, however, were significantly associated with the development of antiretroviral treatment failure (p <0.001) which occurred in nearly a third (139; 27.8%) of the patients.
 Conclusion: There is a high prevalence of CSDIs between ART and CPDs most of which were categorized as moderate. Further studies are required to evaluate the pharmacokinetic and clinical relevance of these interactions.

Early Antiretroviral Therapy in AIDS Patients Presenting With Toxoplasma gondii Encephalitis Is Associated With More Sequelae but Not Increased Mortality

“…The population in our study has three notable characteristics (i) ART-naïve HIV individuals, (ii) the occurrence of TE as an influential factor on the decision to start ART early or administer treatment for the coinfections first, and (iii) a large proportion of patients who at the time of inclusion in the study already had advanced HIV/AIDS disease, with low CD4 + lymphocyte count and CD4 + /CD8 + ratio, and a high viral load. The presence of an ANI in ART-naive patients will always bring major therapeutic challenges associated with the possibility of developing immune reconstitution inflammatory syndrome (IRIS) (30,31) and complex pharmacokinetic interactions and pharmacological co-toxicities (32,33), which not only occur between ART and coinfections' treatment but also with drugs used chronically to treat other comorbidities (34,35).…”

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study

“…In PLWHV, management of comorbidities is often relegated 17 ; antiretroviral medications are usually regarded as being more important than medications for hypertension, resulting in better adherence to the former 12,18,19 . Furthermore, the potential for drug‐drug interaction is higher in multimorbidity 20,21 ; such interactions have been adduced to explain clinical failure of antiretroviral therapy 21 . Thus, interventions involving counselling, education and support for individuals in which both disease conditions co‐exist might be useful, particularly in sub‐Saharan Africa 17,22 …”

South African healthcare workers’ knowledge of dolutegravir's drug–drug interactions in the first year of its rollout: a cross‐sectional online survey

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