SOEDAK2009 --- PREPARE FOR THE LONG RUN

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Titel
Prevalence of potential drug-drug interactions in the Swiss HIV Cohort Study
Autor
Catia Marzolini1, Sara Gibbons2, Luigia Elzi1, Saye Khoo2, Bruno Ledergerber3, David Back2, Manuel Battegay1, Swiss HIV Cohort Study Members
Abstract
Background: Drug-drug interactions (DDIs) related to HIV therapies continue to expand with new drugs, more complex ART regimens, and increasing age-related comorbidities. The identification, resolution and prevention of DDIs are important determinants for clinical management as it may prevent treatment failure and toxicity. This study investigates the prevalence of DDIs (HIV/HIV drugs and HIV/non-HIV drugs) within Swiss HIV Cohort Study (SHCS) patients.
Methods: Detailed SHCS medication forms were screened for potential DDIs during a 3 month period of time using a customised version of the University of Liverpool drug interaction database (www.hiv-druginteractions.org). Physicians were subsequently informed of clinically relevant DDIs.
Results: Medical prescriptions were analyzed for 771 ART-treated patients. ART-regimens were mostly PI-based (41%) and NNRTI-based (39%) with tenofovir/emtricitabine as NRTI backbone (38%). 516 patients had a co-medication, of whom 337 had at least one DDI. Of these, 11 patients (2%) had red flag DDIs (i.e. contra-indicated) and 333 patients (65%) had orange flag DDIs (i.e. potential dose modification or close monitoring). 35 patients (7%) had HIV/HIV drug interactions, whereas 316 patients (61%) had HIV/non-HIV drug interactions. HIV/non-HIV drug interactions involved mainly ATV/r (21%), LPV/r (22%) and EFV (26%) with methadone (14%), cardiovascular drugs (mostly B-blockers and Ca channel inhibitors; 13%), statins (20%) and CNS drugs (mostly SSRIs and BZDs; 23%). 16 patients (3%) had a DDI that could have lowered the HIV drug concentration. In the multivariate analysis, older patients (P< 0.001) and IDU patients (P=0.001) were most likely to have a co-medication. Independent risk factors for DDIs were IDU patients (P=0.005), PI+NNRTI-based regimens (P=0.002) and >2 co-medications (P< 0.001). No association was found between DDIs and virological failure.
Conclusion: Clinically significant DDIs related to HIV therapy are common. The www.hiv-druginteractions.org database constitutes a valuable tool for the identification of DDIs in clinical practice.

Datei SOEDAK_09_OSD4.pdf