Jakeman Bernadette, Nasiri Mona, Ruth Lindsey, Morse Caroline, Mahatme Sheran, Patel Nimish
1 University of New Mexico College of Pharmacy, Albuquerque, NM, USA.
2 Albany College of Pharmacy and Health Sciences, NY, USA.
Ann Pharmacother. 2017 May;51(5):365-372. doi: 10.1177/1060028016685115. Epub 2016 Dec 20.
HIV-infected patients receiving antiretroviral therapy (ART) are at risk for contraindicated drug-drug interactions (XDDIs).
This study compared the frequency of XDDIs between different types of ART regimens.
A retrospective cohort study was performed among adult HIV-infected patients receiving care at either the Upstate New York Veterans' Healthcare Administration or the University of New Mexico Truman Health Services between 2000 and 2013. The cohort consisted of patients receiving traditional ART regimens composed of 2 nucleoside reverse transcriptase inhibitors plus either a nonnucleoside reverse transcriptase inhibitor (NNRTI), a protease inhibitor (PI), or an integrase strand transfer inhibitor (INSTI). The primary outcome was the presence of XDDIs. Lexi-Interact was used to define XDDIs.
Of the 1329 patients who met inclusion criteria, 45.7%, 34.2%, and 20.1% were receiving an NNRTI-, PI-, or INSTI- based ART regimen, respectively. Among the 128 (9.6%) patients with an XDDI, more than half (53.9%) had an interaction involving ART. The presence of XDDIs was highest for PI-based regimens (16.3%) compared with INSTI- (7.9%) and NNRTI-based (5.4%) regimens; P < 0.001. The variables independently associated with XDDIs were ART regimen type (prevalence ratio [PR] = 1.91; 95% CI = 1.51-2.40, P < 0.001), use of ≥6 non-HIV medications (PR = 5.84; 95% CI = 3.92-8.71, P < 0.001), and age ≥40 years (PR = 1.62; 95% CI = 0.92-2.86, P = 0.10).
The probability of XDDIs varies as a function of ART regimen type, advanced age, and use of multiple non-HIV medications.
接受抗逆转录病毒疗法（ART）的HIV感染患者存在禁忌药物相互作用（XDDIs）的风险。
本研究比较了不同类型ART方案之间XDDIs的发生频率。
对2000年至2013年期间在纽约州北部退伍军人医疗管理局或新墨西哥大学杜鲁门健康服务中心接受治疗的成年HIV感染患者进行了一项回顾性队列研究。该队列由接受传统ART方案的患者组成，这些方案由2种核苷类逆转录酶抑制剂加1种非核苷类逆转录酶抑制剂（NNRTI）、1种蛋白酶抑制剂（PI）或1种整合酶链转移抑制剂（INSTI）组成。主要结局是XDDIs的存在情况。使用Lexi-Interact来定义XDDIs。
在符合纳入标准的1329例患者中，分别有45.7%、34.2%和20.1%的患者接受基于NNRTI、PI或INSTI的ART方案。在128例（9.6%）发生XDDIs的患者中，超过一半（53.9%）的相互作用涉及ART。与基于INSTI（7.9%）和基于NNRTI（5.4%）的方案相比，基于PI的方案中XDDIs的发生率最高（16.3%）；P<0.001。与XDDIs独立相关的变量为ART方案类型（患病率比[PR]=1.91；95%CI=1.51-2.40，P<0.001）、使用≥6种非HIV药物（PR=5.84；95%CI=3.92-8.71，P<0.001）以及年龄≥40岁（PR=1.62；95%CI=0.92-2.86，P=0.10）。
XDDIs的发生概率因ART方案类型、高龄以及使用多种非HIV药物而有所不同。
