评估抗逆转录病毒和抗癫痫药物相互作用对赞比亚门诊就诊的 HIV 感染者治疗效果的影响。
Evaluating the impact of antiretroviral and antiseizure medication interactions on treatment effectiveness among outpatient clinic attendees with HIV in Zambia.
机构信息
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Neurology, University of Rochester, Rochester, NY, USA.
出版信息
Epilepsia. 2020 Dec;61(12):2705-2711. doi: 10.1111/epi.16723. Epub 2020 Oct 21.
OBJECTIVE
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.
METHODS
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.
RESULTS
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).
SIGNIFICANCE
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.
目的
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。
方法
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。
结果
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）。
意义
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。
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