Abstract P30
Antiviral Therapy 2019; 24 Suppl 1:A79
Discrepancies in grading of drug–drug interactions in an elderly HIV population using three different expert databases
AL Ruellan
1
, D Bourneau
2
, C Joyau
1
, S Sécher
1
,
C Allavena
1
1CHU de Nantes, Nantes, France; 2CHU d'Angers, Angers, France
Objectives: Comorbidities and polypharmacy have been associated with adverse drug reactions, misuse and drug–drug interactions (DDI) with an increasing risk in the elderly population living with HIV. Different expert databases can be used to evaluate DDIs with sometimes divergent interpretations that complicate therapeutic management. The objective was to describe DDIs between antiretrovirals (ARVs) and co-medications in an elderly HIV-population and to compare analyses and interpretations between three accessed databases.
Methods: All prescribed treatments (ARVs and co-medications) of HIV-infected subjects aged 65 years and older followed in five French HIV centers were collected during an HIV routine visit. Three expert databases, the Summary of Product Characteristic (SPC), the National DDI Thesaurus (THES), and the Liverpool HIV DDI (LIV) were used to define each DDI and specific grade. Relevant DDIs were defined as DDI mentioned in SPC and/or THES whatever the grade and/or moderate/high quality of evidence of interaction in the Liverpool website. DDIs were classified in potential weak interaction (undefined grade 1* in SPC and THES or potential weak interaction 1* in LIV), potential interaction (grade 1 or 2 in SPC and THES and grade 1 in LIV) and contraindication (grade 3 or 4 in SPC and THES and grade 2 in LIV).
Results: From January to March 2017, 239 HIV-infected subjects aged 65 years and older receiving both ARVs and comedications were included: median age 69 years (IQR 67–73), male 78%, median duration of HIV infection 18 years (12–24), 73% with at least one comorbidity, receiving a median of 5 comedications (2–7). Of these, 60 subjects (25.1%) presented at least one DDI for a total of 128 DDIs: 23/128 DDIs were contraindicated in 10 subjects. Contraindications are detailed in Table 1.
All DDIs have been identified in LIV but only 12/21 (57%) at the highest grade, among which THES missed 5 high grade DDIs. Only seven contraindications have been identified in the three databases concomitantly at the highest grade: darunavir/alfuzosin, darunavir/ apixaban, darunavir/ticagrelor, ritonavir/alfuzosin, ritonavir/apixaban, ritonavir/ticagrelor and nevirapine/ ketoconazole.
Conclusions/discussion: Protease inhibitors and boosters are frequently involved in serious DDIs as well as comedications mostly prescribed in the ageing population such as anti-platelet agent and alpha blocker (prescribed in benign prostatic hypertrophy). Different methodologies can explain the discrepancies between the three accessed databases. SPC and THES based their recommendations on clinical and pharmacological data, while LIV, the most used and convenient database, with evidence-based DDI resource is mainly based on pharmacological data. A consensus within the databases would be helpful for clinicians.
Abstract P31
Antiviral Therapy 2019; 24 Suppl 1:A81
BESIDE – clinical relevance and implications for management of antiretroviral therapy due to recreational drug use in PLWH in Germany
B Funke
1
,
K Martin
1
, CD Spinner
2
, S Christensen
3
, H Heiken
4
, H Knechten
5
, S Usadel
6
, T Wuensche
7
, V Witte
1
1MSD Sharp & Dohme GmbH, Medical Affairs, Haar, Germany; 2Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Medicine II, Munich, Germany; 3Center for Interdisciplinary Medicine (CIM), Muenster, Germany; 4Praxis Georgstrasse, Hannover, Germany; 5PZB Aachen, Medical Center for Infectious Diseases, Aachen, Germany; 6Infektionsmedizin Freiburg, Freiburg, Germany; 7Praxis Wuensche, Berlin, Germany
Background: Recreational drug use among people living with HIV (PLWH) in Germany is common. This puts patients at risk for drug–drug interactions potentially leading to adverse events and/or loss of efficacy of antiretroviral therapy (ART). Here, we assessed the clinical relevance of illicit drug consumption and potential implications for management of ART.
Methods: BESIDE was a cross-sectional study, evaluating the prevalence of concomitant diseases, prescription and over the counter co-medication as well as illicit drugs in PLWH on ART. Regional distribution of study sites (n=20), consecutive recruitment and age-stratified sampling ensured a representative sample of the PLWH population in Germany. Data on recreational drug use were gathered via anonymized patient questionnaires.
Results: Between 09/2016 and 12/2018, centres collected data of 453 PLWH on ART. A high proportion of patients with data available (76%; 223/293) consumed recreational drugs, 21% (47/223) to stimulate sexual activities. 71% (207/293) of patients had been asked about drugs by their doctors and 66% (194/293) had been educated on potential risks and interactions. However, no more than 29% (65/223) of patients sought consultation with their doctor about their drug use and only 7% (15/223) saw a problem in the use of drugs in combination with ART. Strikingly, 39% (86/223) of patients had undergone medical treatment and 36% (81/223) had been hospitalized due to their drug consumption, with even more concerning numbers in patients aged <30 years (medical treatment: 60%, 12/20; hospitalization: 65%, 13/20). This was consistent with a high number of patients who had problems with their ART (31%, 70/223; <30 y: 60%, 12/20) or needed to switch it (28%, 62/223; <30 y, 60%, 12/20) due to recreational drug use.
Conclusions: These data demonstrate the high clinical relevance of recreational drug use in PLWH and the need for pro-active education on potential risks and drug–drug interactions with ART by treating physicians, especially of younger patients.
