Prevalence, beliefs and impact of drug-drug interactions between antiretroviral therapy and illicit drugs among people living with HIV in Spain

Abstract

Drug use implies important challenges related to HIV management, particularly due to an increased risk of potential interactions between antiretroviral therapy (ART) and illicit drugs (pDDIs). This study analyses the prevalence and severity of pDDIs among people living with HIV (PLHIV). It also explores their awareness of pDDIs and their beliefs about the toxicity that they may cause, as well as the impact of pDDIs on selected health variables. We conducted an on-line cross-sectional survey across 33 Spanish hospitals and NGOs to collect demographics and clinical data. pDDIs were checked against the Interaction Checker developed by Liverpool University. The sample of the present study was composed of 694 PLHIV who used illicit drugs. They represented 49.5% of the 1,401 PLHIV that participated in the survey. After excluding 38 participants due to lack of information on their ART or illicit drug use, 335 (51.1%) participants consuming drugs presented with some potentially significant pDDIs between their ART and illicit drugs, with a mean of 2.1±1.7 (1–10) pDDIs per patient. The drugs most frequently involved in pDDIs were cocaine, cannabis, MDMA and nitrates ("poppers"). The prevalence of pDDIs across ART regimens was: protease inhibitors (41.7%); integrase inhibitor-boosted regimens (32.1%), and non-nucleoside reverse transcriptase inhibitors (26.3%). An awareness of pDDIs and beliefs about their potential toxicity correlated positively with intentional non-adherence (p<0.0001). Participants with pDDIs exhibited a higher prevalence of intentional non-adherence (2.19±1.04 vs. 1.93±0.94; p = 0.001). The presence of pDDIs was not associated with poorer results in the clinical variables analysed. A significant proportion of PLHIV who use drugs experience pDDIs, thereby requiring close monitoring. pDDIs should be considered in the clinical management of HIV patients. Adequate information about pDDIs and indicators about how to manage ART when PLHIV use drugs could improve ART non-adherence.

Could Long-Acting Cabotegravir-Rilpivirine Be the Future for All People Living with HIV? Response Based on Genotype Resistance Test from a Multicenter Italian Cohort

“…This is encouraging since long-acting CAB/RPV probably ensures a good response to a switch strategy that includes the same drug class. It should also be noted that in recent years, the proactive switch involves mainly these drug classes rather than PIs in order to limit their well-known toxicity [12,20,21].…”

“…However, several downsides have emerged or remain critical: (i) the therapy is lifelong; (ii) the oral route is the only path of administration, leading to issues for patients with dysphagia or altered consciousness; (iii) all available compounds need to be taken daily, which requires high compliance by the patient; (iv) the aging of the HIV-population also leads to age-related pathologies (e.g., dementia) [9][10][11]; (v) polypharmacotherapy must account for the risk of incorrect drug assumption and interaction [12]; (vi) there are still patients with limited treatment options due to viral resistance for those in whom preserving available molecules remains critical [13,14]; and (vii) the current SARS-CoV-2 pandemic has led to a more complex and discontinued retention in care and treatment adherence [15]. Currently, clinicians should evaluate all the previously described characteristics to prescribe the perfect treatment for each person.…”

Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy—Update 2022: Systematic Review

“…Drug substance misuse is an important consideration in PLHIV on ARV therapy, requiring an integrated approach based on evidence [2]. Therefore, there are clinically relevant drug interactions associated with drug substance misuse, such as ketamine, amphetamine, and substitutes (methamphetamine, methylenedioxymethamphetamine-MDMA; 'ecstasy') with RTV-boosted PIs [14,[75][76][77][78][79][80] and EVG/COBI [14,15,75,76,80,142,143], increasing the risk of toxicity, including a possible fatal serotonergic reaction. Furthermore, clinically relevant interactions were identified between psychotropic drugs, particularly benzodiazepines, which have the potential to cause dependence in patients.…”

The Impact of Drugs and Substance Abuse on Viral Pathogenesis—A South African Perspective

“…Subsequently, drug–drug interactions between drugs of abuse and ART drugs mediated by CYP enzymes may result in the decreased adherence to ART, leading to an increased HIV replication in HIV-infected individuals [ 134 ]. Although highly active ART has been a great success, new challenges have arisen that could lead to the failure of the treatment [ 135 , 136 ]. One of these challenges is the appearance of interactions between ART drugs and medications or illicit drugs taken concurrently [ 135 , 136 ].…”

“…Although highly active ART has been a great success, new challenges have arisen that could lead to the failure of the treatment [ 135 , 136 ]. One of these challenges is the appearance of interactions between ART drugs and medications or illicit drugs taken concurrently [ 135 , 136 ]. Consequently, as some nyaope cocktails contain ARVs, nyaope use could also lead to the poor adherence to ART drugs.…”