Prevalence of potential drug-drug interactions in HIV-infected adults taking antiretroviral drugs at Vajira Hospital
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Abstract
Background: Patients with HIV who are receiving antiretroviral (ARV) therapy are at risk for drug interactions. Potential drug-drug interactions (PDDIs) are frequent. Data regarding potential drug-drug interactions in HIV-positive individuals in Thailand are limited.
Objectives: To investigate the prevalence and risk factors of PDDIs between ARVs and co-administered drugs. Material and Method: A retrospective study of HIV patients treated at the infectious clinic of Vajira Hospital was performed from April 2014 to June 2014. PDDIs were screened by using the Liverpool drug interactions database, defined as red flag interaction (contraindicated, avoid, or not recommended), and orange flag interaction (caution, close monitoring, or capable of causing clinical deterioration).
Results: Of 1,320 patients, 711 (53.86%) were male and the mean age was 44 ± 9 years. Median CD4 count was 495 cells/mm3 (11-1,657). Fourteen (1.06%) had tuberculosis coinfection. Overall 82.05% and 20.38% of patients received Non-nucleoside reverse-transcriptase inhibitors (NNRTI) and protease inhibitor (PI)-based regimens, respectively. Nevirapine is the most commonly used NNRTI (49.09%) while Lopinavir/ritonavir (LPV/r) is the most commonly used in PI (74.63%). A total of 533 patients out of 1,320 HIV patients (40.38%) were at risk for a PDDI. Red flag interactions were 1.81% (12/664 events) and orange flag interactions were 98.19% (652/664 events). Major interactions most frequently involved rifampicin in red flag interactions and statins in orange flag interactions. In the multivariate analysis, factors associated with having PDDIs were male gender (OR 1.30, 95% CI 1.01-1.68), advanced age (age ≥ 50 years) (OR 2.20, 95% CI 1.63-2.95), 2 co-medications (OR 13.56, 95% CI 8.53-21.55), ≥ 3 co-medications (OR 41.07, 95% CI 12.68-133.06), and tuberculosis coinfection (OR 44.02, 95% CI 2.62-739.47) respectively.
Conclusions: The prevalence of PDDIs is high among HIV-infected adults on ARV drugs at Vajira Hospital. The risk for PDDIs increased significantly in males, aged ≥ 50 years, with polypharmacy, and coinfection with tuberculosis.
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References
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