Polypharmacy and potential drug–drug interactions among people living with HIV in the era of integrase strand transfer inhibitor-based antiretroviral therapy

Abstract

We aimed to investigate the prevalence of polypharmacy and potential drug-drug interactions (DDIs) and the associated factors with DDIs among people living with HIV (PLWH) in the modern era of antiretroviral therapy (ART). This cross-sectional study included PLWH who had been on ART for at least 3 months at two designated hospitals for HIV care in Taiwan. All ART and non-ART prescriptions were collected from the NHI-MediCloud System and screened for DDIs using the University of Liverpool HIV drug interactions database. A case-control analysis was conducted to investigate the factors associated with DDIs. From June 2021 to August 2022, 1007 PLWH were included. Their median age was 40 years (interquartile range, 33-49) and 96.2% were taking INSTI-based ART. The proportions of PLWH with at least 1 non-communicable diseases and polypharmacy were 50.0% and 18.7%, respectively. Seven (0.7%) PLWH had red-flagged DDIs, and 159 (15.8%) had amber-flagged DDIs. In multivariable models, the prevalence of DDIs was higher in PLWH with an older age (aOR, per 1-year increase, 1.022), number of co-medications (aOR, 1.097), use of boosted INSTI-based ART (versus unboosted INSTI, aOR, 8.653), and concomitant medications in the category of alimentary tract and metabolism (aOR, 11.058) and anti-neoplastic and immunomodulating agents (aOR, 14.733). In the INSTI era, the prevalence of potential DDIs was lower than previously noted, but remained substantial. Clinicians should routinely monitor DDIs, especially in older PLWH, those with increased number of co-medications, and those who are taking booster-containing ART or medications from specific categories.