Abstract
Background: HIV/AIDS usually present with comorbid diseases such as tuberculosis, pneumonia, toxoplasmosis, fungal infections, etc., that need multiple medications. Potential interaction between ARV and comorbid drugs is unavoidable. Objective: This study aimed to investigate the potential interaction between ARV drugs and medications used to treat comorbid diseases among HIV patients at the Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods: This was an observational study using medical record data of 121 HIV/AIDS patients treated at the CM Hospital between January 2016 and July 2017. Potential interaction was classified as “major” if it could lead to increase or decrease of plasma drug levels which potentially result in either drug toxicity or treatment failure, or clinically significant harm to the patient; “moderate” if the interaction is not major, but with the recommendation of close monitoring. National, European, Australian, and Liverpool iChart guidelines were used for the classification of drug interactions. Results: Major interactions were noted in 17 (14.05%)patients. Fourteen of them received rifampicin, which potentially decreases plasma level of nevirapine (9 patients), rilpivirine (1 patient), and lopinavir/ritonavir (4 patients). Potential increase of ARV level was found in 3 patients involving interaction between voriconazole-efavirenz (2) and omeprazole-rilpivirine (1). Moderate interaction with the potential decrease of ARV level occurred in 46 patients (38.01%); consisting of a combination of rifampicin with efavirenz (38 pts), rifampicin with zidovudine (6 pts), and phenytoin with efavirenz or nevirapine (2 patients). Conclusion: Potential major interaction occurred in 17 (14.05%), which mostly attributed to rifampicin use; while moderate interaction occurred in 46 (38.01%) of patients. Although no serious adverse event was observed in this study, special care should be taken when the drugs with potential major interaction are to be administered
Highlights
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) commonly present with comorbidities, such as tuberculosis, hepatitis, candidiasis, pneumonia, and others that need multiple medications
Moderate interaction with the potential decrease of ARV level occurred in 46 patients (38.01%); consisting of a combination of rifampicin with efavirenz (38 pts), rifampicin with zidovudine (6 pts), and phenytoin with efavirenz or nevirapine (2 patients)
Potential major interaction occurred in 17 (14.05%), which mostly attributed to rifampicin use; while moderate interaction occurred in 46 (38.01%) of patients
Summary
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) commonly present with comorbidities, such as tuberculosis, hepatitis, candidiasis, pneumonia, and others that need multiple medications. In this situation, drug-drug interaction that may influence plasma drug levels with the consequences of side effects or treatment. Co-administration of these drugs could lead to a decrease in the ARV plasma level, which may cause HIV treatment failure. A study in Switzerland reported that 40% of patients showed potential interaction among ARV drugs [3]. A study in Liverpool reported that 27% of 159 patients had the potential ARV interaction, and 15% had a potency to decrease the plasma level of ARV drug [4].
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