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在澳大利亚,接受抗逆转录病毒疗法的艾滋病毒感染者因同时使用药物而产生的潜在药物相互作用。

Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia.

机构信息

Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.

Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.

出版信息

Br J Clin Pharmacol. 2023 May;89(5):1541-1553. doi: 10.1111/bcp.15614. Epub 2022 Dec 12.


DOI:10.1111/bcp.15614
PMID:36434744
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10953433/
Abstract

AIMS: We quantified concomitant medicine use and occurrence of potential drug-drug interactions in people living with HIV in Australia who are treated with antiretroviral therapy (ART). METHODS: In this cohort study using dispensing claims of a 10% random sample of Australians, we identified 2230 people dispensed ART between January 2018 and December 2019 (mean age 49.0 years, standard deviation 12.0 years, 88% male). We examined concomitant medicine use by identifying nontopical medicines dispensed within 90-days of any antiretroviral medicine dispensing during a 12-month follow-up period. For every antiretroviral and nonantiretroviral pair, we identified and classified possible drug-drug interactions using the University of Liverpool HIV drug interactions database. RESULTS: A total of 1728 (78%) people were dispensed at least 1 and 633 (28%) 5 or more unique medicines in addition to ART in a 12-month period; systemic anti-infectives and medicines acting on the nervous system were the most common (68% and 56%, respectively). Among comedicated people, 1637 (95%) had at least 1 medicine combination classified as weak interactions, 558 (32%) interactions requiring close monitoring/dose adjustment and 94 (5%) that should not be coadministered. Contraindication or interactions requiring close monitoring/dose adjustment were more common among people receiving protease inhibitors (50-73% across different antiretrovirals), non-nucleoside reverse transcriptase inhibitors (35-64%), people using single-tablet combinations containing elvitegravir (30-46%) and those using tenofovir disoproxil (26-30%). CONCLUSION: Concomitant medicine use is widespread among people living with HIV in Australia. Despite a relatively low prevalence of contraindicated medicines, almost a third received medicines that require close monitoring or dose adjustment.

摘要

目的:我们定量评估了澳大利亚接受抗逆转录病毒疗法(ART)治疗的艾滋病毒感染者同时使用药物的情况以及潜在药物相互作用的发生情况。

方法:在这项基于配药记录的队列研究中,我们对澳大利亚 10%随机样本中的 2230 名在 2018 年 1 月至 2019 年 12 月期间接受 ART 治疗的患者进行了识别。我们通过在 12 个月的随访期间内,确定在任何抗逆转录病毒药物配药后 90 天内配给的非局部药物,来检查同时使用的药物。对于每一对抗逆转录病毒药物和非抗逆转录病毒药物,我们使用利物浦大学艾滋病毒药物相互作用数据库来识别和分类可能的药物相互作用。

结果:在 12 个月内,共有 1728 人(78%)除了接受 ART 之外,还至少配给了 1 种和 633 人(28%)5 种或更多的独特药物;全身性抗感染药和作用于神经系统的药物最为常见(分别占 68%和 56%)。在合并用药的患者中,1637 人(95%)至少有一种药物组合被归类为弱相互作用,558 人(32%)需要密切监测/剂量调整,94 人(5%)不应联合使用。在接受蛋白酶抑制剂(不同抗逆转录病毒药物的比例为 50-73%)、非核苷类逆转录酶抑制剂(35-64%)、使用含有艾维雷格韦的单一片剂组合(30-46%)和使用替诺福韦二吡呋酯(26-30%)的患者中,禁忌药物或需要密切监测/剂量调整的药物更为常见。

结论:在澳大利亚,艾滋病毒感染者同时使用药物的情况很普遍。尽管禁忌药物的患病率相对较低,但近三分之一的患者接受了需要密切监测或剂量调整的药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fea/10953433/f6a6091dcfcb/BCP-89-1541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fea/10953433/582ac14fe70b/BCP-89-1541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fea/10953433/f6a6091dcfcb/BCP-89-1541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fea/10953433/582ac14fe70b/BCP-89-1541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fea/10953433/f6a6091dcfcb/BCP-89-1541-g001.jpg

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本文引用的文献

[1]
Comorbidity and comedication burden among people living with HIV in the United States.

Curr Med Res Opin. 2022-8

[2]
Potential drug-drug interactions between antiretroviral drugs and comedications, including dietary supplements, among people living with HIV: A clinical survey.

HIV Med. 2023-1

[3]
Antibiotic prescription for HIV-positive patients in primary health care in Mozambique: A cross-sectional study.

S Afr J Infect Dis. 2022-2-28

[4]
Adherence to Antiretroviral Regimens in Australia: A Nationwide Cohort Study.

AIDS Patient Care STDS. 2020-2

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The challenge of HIV treatment in an era of polypharmacy.

J Int AIDS Soc. 2020-2

[6]
Comedication prescription patterns and potential for drug-drug interactions with antiretroviral therapy in people living with human immunodeficiency virus type 1 infection in Germany.

Pharmacoepidemiol Drug Saf. 2020-3

[7]
Comorbidity Medications Are Dispensed to More People Receiving Antiretroviral Therapy for HIV Compared with the General Population in Australia.

AIDS Res Hum Retroviruses. 2020-4

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PLoS One. 2019-10-9

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Risk of myocardial infarction among people living with HIV: an updated systematic review and meta-analysis.

BMJ Open. 2019-9-24

[10]
Polypharmacy and Drug-Drug Interactions in People Living With Human Immunodeficiency Virus in the Region of Madrid, Spain: A Population-Based Study.

Clin Infect Dis. 2020-7-11

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