Miller Christopher D, El-Kholi Ramy, Faragon John J, Lodise Thomas P
Department of Pharmacy Practice, Albany College of Pharmacy, Albany, New York 12208, USA.
Pharmacotherapy. 2007 Oct;27(10):1379-86. doi: 10.1592/phco.27.10.1379.
To identify the prevalence and types of clinically significant drug interactions (CSDIs) in the drug regimens of patients with human immunodeficiency virus (HIV) infection who were receiving antiretroviral therapy, and to explore risk factors for these CSDIs.
Retrospective medical record review.
Academic HIV specialty clinic.
One hundred fifty-three randomly selected patients with HIV infection who were receiving antiretroviral therapy from May 1-September 30, 2006.
Data were collected on patient demographics, date of HIV diagnosis, most recent viral load and CD4(+) count, Centers for Disease Control and Prevention HIV classification, and comorbid conditions. Patients' drug regimens were analyzed for total and clinically significant antiretroviral drug interactions using three resources. Logistic regression and classification and regression tree analysis were used to identify independent CSDI predictors. Clinically significant drug interactions were defined as drug interactions that required a dosage adjustment or consisted of a drug combination that is contraindicated due to its high potential for clinical adverse effects. Of the 153 patients, at least one CSDI was found in 41.2% of their regimens: 34.6% with at least one drug interaction that required a dosage adjustment, 2.0% with at least one contraindicated drug combination, and 4.6% with at least one of each of these CSDIs. In the logistic regression model, risk factors independently associated with CSDIs were age older than 42 years (odds ratio [OR] 2.9, 95% CI 1.2-7.1), more than three comorbid conditions (OR 3.0, 95% CI 1.4-6.6), treatment with more than three antiretroviral agents (OR 2.4, 95% CI 1.0-5.8), and treatment with a protease inhibitor (OR 11.5, 95% CI 4.2-31.2). When directly compared, CSDIs were more prevalent among protease inhibitor-based than nonnucleoside reverse transcriptase inhibitor-based regimens (p<0.001).
Clinically significant drug interactions are highly prevalent among HIV-infected patients receiving antiretroviral therapy. Knowledge of the risk factors for CSDIs may help clinicians recognize and manage CSDIs.
确定接受抗逆转录病毒治疗的人类免疫缺陷病毒（HIV）感染患者药物治疗方案中具有临床意义的药物相互作用（CSDI）的患病率和类型，并探讨这些CSDI的危险因素。
回顾性病历审查。
学术性HIV专科诊所。
2006年5月1日至9月30日期间随机选取的153例接受抗逆转录病毒治疗的HIV感染患者。
收集患者人口统计学资料、HIV诊断日期、最近的病毒载量和CD4(+)细胞计数、疾病控制与预防中心HIV分类以及合并症情况。使用三种资源分析患者的药物治疗方案中总的和具有临床意义的抗逆转录病毒药物相互作用。采用逻辑回归和分类与回归树分析来确定独立的CSDI预测因素。具有临床意义的药物相互作用定义为需要调整剂量的药物相互作用或因具有高临床不良反应可能性而禁忌的药物组合。在153例患者中，41.2%的治疗方案中发现至少一种CSDI：34.6%的患者至少有一种需要调整剂量的药物相互作用，2.0%的患者至少有一种禁忌药物组合，4.
