Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Neurology, University of Rochester, Rochester, NY, USA.
Epilepsia. 2020 Dec;61(12):2705-2711. doi: 10.1111/epi.16723. Epub 2020 Oct 21.
Interactions between enzyme-inducing anti-seizure medications (EI-ASMs) and antiretroviral drugs (ARVs) can lead to decreased ARV levels and may increase the likelihood of viral resistance. We conducted a study to determine if co-usage of ARVs and EI-ASMs is associated with ARV-resistant human immunodeficiency virus (HIV) among people living with HIV in Zambia.
Eligible participants were ≥18 years of age and concurrently taking ASMs and ARVs for at least 1 month of the prior 6-month period. Data were obtained regarding medication and HIV history. CD4 counts, plasma viral loads (pVLs), and HIV genotype and resistance profile in participants with a pVL >1000 copies/mL were obtained. Pearson's test of independence was used to determine whether treatment with EI-ASM was associated with pVL >1000/mL copies.
Of 50 participants, 41 (82%) were taking carbamazepine (37 on monotherapy), and all had stable regimens in the prior 6 months. Among the 13 ARV regimens used, 68% had a tenofovir/lamivudine backbone. The majority (94%) were on a stable ARV regimen for >6 months. Median CD4 nadir was 205 cells/mm (interquartile range [IQR] 88-389), and 60% of participants had commenced ARV treatment before advanced disease occurred. Mean CD4 count at enrollment was 464 cells/mm (SD 226.3). Seven participants (14%) had a CD4 count <200 cells/mm . Four (8%) had a pVL >1000 copies/mL; all were on carbamazepine. Three participants with elevated pVL had a CD4 count <200 cells/mm . None had documented adherence concerns by providers; however, two had events concerning for clinical failure. HIV genotype testing showed mutations in three participants. Carbamazepine was not found to correlate with elevated pVL (P = .58).
EI-ASMs are commonly used in sub-Saharan Africa. Despite concurrent use of EI-ASMs and ARVs, the majority of participants showed CD4 counts >200 cells/mm and were virally suppressed. Carbamazepine was not associated with an increased risk of virological failure or ARV-resistant HIV.
酶诱导抗癫痫药物（EI-ASMs）与抗逆转录病毒药物（ARVs）之间的相互作用可导致 ARV 水平降低，并可能增加病毒耐药的可能性。我们进行了一项研究，以确定赞比亚的 HIV 感染者中，同时使用 ARVs 和 EI-ASMs 是否与 ARV 耐药性人类免疫缺陷病毒（HIV）有关。
合格的参与者年龄≥18 岁，且在过去 6 个月的前 1 个月中同时服用 ASMs 和 ARVs。获得有关药物和 HIV 病史的数据。对于 pVL>1000 拷贝/mL 的参与者，获得 CD4 计数、血浆病毒载量（pVL）以及 HIV 基因型和耐药性。使用 Pearson 独立性检验来确定 EI-ASM 的治疗是否与 pVL>1000/mL 拷贝相关。
在 50 名参与者中，有 41 名（82%）正在服用卡马西平（37 名单独服用），并且所有人在过去 6 个月中均有稳定的治疗方案。在使用的 13 种 ARV 方案中，有 68%使用了替诺福韦/拉米夫定作为骨干。大多数（94%）的人已经使用稳定的 ARV 方案>6 个月。中位 CD4 最低点为 205 个细胞/mm（四分位距 [IQR] 88-389），有 60%的参与者在发生晚期疾病之前就已经开始接受 ARV 治疗。入组时的平均 CD4 计数为 464 个细胞/mm（标准差 226.3）。有 7 名参与者（14%）的 CD4 计数<200 个细胞/mm。有 4 名（8%）的 pVL>1000 拷贝/mL；所有人都在服用卡马西平。有 3 名 pVL 升高的参与者的 CD4 计数<200 个细胞/mm。没有发现提供者有与药物服用有关的问题；但是，有两个事件与临床失败有关。HIV 基因型检测显示有 3 名参与者存在突变。卡马西平与升高的 pVL 无关（P=.58）。
EI-ASMs 在撒哈拉以南非洲地区广泛使用。尽管同时使用 EI-ASMs 和 ARVs，但大多数参与者的 CD4 计数>200 个细胞/mm，并且病毒得到抑制。卡马西平与病毒学失败或 ARV 耐药性 HIV 无关。
