Abstract
Introduction: The rapid increase in access to antiretroviral therapy in developing countries has brought with it new challenges. The management of risk by the clinical pharmacist may improve HIV patient’s health in poor resources setting. We assessed risk criteria for drug-drugs interactions to inform clinicians. Methods: This transversal work included patients at the beginning of ART treatment. From January to August 2015, HIV seropositive attending for care at Infectious and Tropical diseases Unit of Treichville teaching Hospital at Abidjan. The guidelines for entry into the antiretroviral program has been used. All the coprescribed drugs were screened for potential for Drugs-Drugs significate interactions using the Liverpool HIV Pharmacology Group website (www.hiv-druginteractions.org). Also many others books and website have been used to analyse drugs interactions. Finally, the French Clinical pharmacy guideline allowed to stratify the pharmaceutical interventions. Results: Of 562 patients screened, 228 patients were included in the final analysis, comprising 91(39.91%) male and 137(60.9%) females; aged between 35-48 years (median 41 years), unmarried 160(63.18%), 218(95.61%) HIV1, 117(51.75%) with TB, renal failure 21(9.27%), First line of antiretroviral therapy 198 (86.84%) and 27(11.6%) patients were on second line treatment, Stage C (62.39%), mean Body mass index at baseline of 17.5.1 kg/m2 (range 35-48 kg). Baseline CD4 counts were 200 (IQR 25-75%) (Range 131.5-278) cells/mm3.The use of 1st line regimens were as follows: TDF/3TC/EFV in 141 patients (61.34%). Antiretroviral were prescribed at standard doses, regardless of whether a CR was present or not. Physiopathology stage was identified in 83 patients (36.41%) and potential drugs-drugs interactions with antiretroviral were identified in in 145 patients (63.59%) involving anti infectives for systemic use and anti-parasitic products 131(79.88%), 18(10.98%) traditional plants. The potentials interactions 120(52.63%), contraindicated 25(10.96%) and Biological monitoring 130(57.02%) followed by Substitution/Exchange 47(20.61%) were found. Conclusion: The role of pharmacist to manage patient’s health is very important to decrease the mortality or morbidity linked to HIV.
Highlights
The rapid increase in access to antiretroviral therapy in developing countries has brought with it new challenges
Many factors may alter effectiveness of treatment such as, disease, age, polypharmacy lead to potential drug-drug interactions (PDDIs)
Non-Nucleoside Reverse Transcriptase (NNRT), Protease Inhibitors (PIs) and many others medications have the same pathways during the metabolisation of xenobiotics, which leads to adverse effects with clinically significate (DDSI)
Summary
The rapid increase in access to antiretroviral therapy in developing countries has brought with it new challenges. The management of risk by the clinical pharmacist may improve HIV patient’s health in poor resources setting. The new challenge of the management of patients is no longer the accessibility to the therapeutic combination but rather to the improvement of the quality of life of patients [1]. PIs are substrates and/or inhibitors of drug transporters such as P-glycoprotein which may result in pharmacokinetic drug interactions [2,3,4]. Managing drug-drug interactions is one of the major challenges in the optimization of HIV therapy [5,6]. Using fixed dose combinations does not allow for personalization of therapy (e.g. with coadministered drugs for tuberculosis and HIV)
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