Prevalence of potential drug-drug interactions in patients of the Swiss HIV Cohort Study in the era of HIV integrase inhibitors. Clinical Infectious Diseases
Deutschmann et al. aimed to assess the prevalence of and risk factors for potential drug–drug interactions (PDDIs) between antiretroviral drugs (ARVs) and co-medications in the SHCS for 2018 and to compare the prevalence with a previous analysis performed in 2008.
The University of Liverpool HIV drug interaction database was used to detect PDDIs between ARVs and co-medications and linked with the SHCS database. PDDIs were categorized as harmful (red flagged), of potential clinical relevance (amber flagged), or of weak clinical significance (yellow flagged).
In 9’298 included individuals, median age was 51 years (IQR, 43–58), and 72% were males. Individuals received unboosted integrase inhibitors (INIs) (40%), boosted ARVs (30%), and nonnucleoside reverse transcriptase inhibitor (NNRTIs) (32%)–based regimens. In the entire cohort, 68% received ≥1 co-medication, 14% had polypharmacy (≥5 co-medications) and 29% had ≥1 PDDI. Among individuals with co-medication, the prevalence of combined amber and yellow PDDIs was 43% (33% amber—mostly with cardiovascular drugs—and 20% yellow-flagged PDDIs) compared to 59% in 2008. Two percent had red-flagged PDDIs (mostly with corticosteroids), the same as in the 2008 survey. Compared with 2008, fewer individuals received boosted ARVs (-24%) and NNRTIs (-13%) but the use of co-medications was higher.
In conclusion, the prevalence of PDDIs in the SHCS has decreased in the past decade, although a lower extent than anticipated. This is explained by the fact that half of the population were on unboosted regimens characterized by a favorable interaction profile and by a currently higher co-medication use. Co-medications are unavoidable in the context of an aging population and are often prescribed by non-HIV physicians who may not be aware of the drug interaction risk, notably with boosted regimens. PDDIs may be further reduced by the use of unboosted INIs or noninteracting NNRTIs (i.e., rilpivirine, doravirine), in particular in people living with HIV (PLWH) with multimorbidity and polypharmacy, with regular medication reconciliation and review, and with the systematic use of comprehensive drug interaction search tools for drug prescribing in PLWH.