Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia

Juliana de Oliveira Costa; Stella Lau; Nicholas Medland; Sara Gibbons; Andrea L Schaffer; Sallie-Anne Pearson

doi:10.1111/bcp.15614

Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia

Br J Clin Pharmacol. 2023 May;89(5):1541-1553. doi: 10.1111/bcp.15614. Epub 2022 Dec 12.

Authors

Juliana de Oliveira Costa^{1

2}, Stella Lau³, Nicholas Medland⁴, Sara Gibbons⁵, Andrea L Schaffer⁶, Sallie-Anne Pearson¹

Affiliations

¹ Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
² Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
³ Postgraduate Program in Health Data Science, Centre for Big Data Research in Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
⁴ The Kirby Institute, UNSW Sydney, Sydney, Australia.
⁵ Department of Pharmacology, University of Liverpool, Liverpool, UK.
⁶ Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health/UNSW Sydney, Sydney, Australia.

Abstract

Aims: We quantified concomitant medicine use and occurrence of potential drug-drug interactions in people living with HIV in Australia who are treated with antiretroviral therapy (ART).

Methods: In this cohort study using dispensing claims of a 10% random sample of Australians, we identified 2230 people dispensed ART between January 2018 and December 2019 (mean age 49.0 years, standard deviation 12.0 years, 88% male). We examined concomitant medicine use by identifying nontopical medicines dispensed within 90-days of any antiretroviral medicine dispensing during a 12-month follow-up period. For every antiretroviral and nonantiretroviral pair, we identified and classified possible drug-drug interactions using the University of Liverpool HIV drug interactions database.

Results: A total of 1728 (78%) people were dispensed at least 1 and 633 (28%) 5 or more unique medicines in addition to ART in a 12-month period; systemic anti-infectives and medicines acting on the nervous system were the most common (68% and 56%, respectively). Among comedicated people, 1637 (95%) had at least 1 medicine combination classified as weak interactions, 558 (32%) interactions requiring close monitoring/dose adjustment and 94 (5%) that should not be coadministered. Contraindication or interactions requiring close monitoring/dose adjustment were more common among people receiving protease inhibitors (50-73% across different antiretrovirals), non-nucleoside reverse transcriptase inhibitors (35-64%), people using single-tablet combinations containing elvitegravir (30-46%) and those using tenofovir disoproxil (26-30%).

Conclusion: Concomitant medicine use is widespread among people living with HIV in Australia. Despite a relatively low prevalence of contraindicated medicines, almost a third received medicines that require close monitoring or dose adjustment.

Keywords: HIV; comorbidities; drug interactions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-HIV Agents* / therapeutic use
Anti-Retroviral Agents / therapeutic use
Australia / epidemiology
Cohort Studies
Drug Interactions
Female
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Male
Middle Aged
Reverse Transcriptase Inhibitors

Substances

Reverse Transcriptase Inhibitors
Anti-Retroviral Agents
Anti-HIV Agents