Background and Importance Improved survival of people living with HIV(PLWH) increases comorbidities burden leading to polypharmacy and drug-drug interactions(DDIs). DDIs suppose a higher concern in PLWH due to antiretroviral therapy(ART). Presence so risk factors(RF) for developing DDIs are of interest to detect cases needing for pharmaceutical assessment.
Aim and Objectives Assess literature on the pharmacological RF for developing DDIs in PLWH.
Material and Methods Following the PRISMA recommendations, a search combining terms associated with ‘ART’, ‘DDIs’ and ‘RF’ was conducted in MEDLINE database for relevant English- and Spanish-language articles from 2006 through January 2022. Longitudinal and cross-sectional studies were included. Articles not mentioning data on DDIs between ART and non-ART were excluded in a first screening phase. In a subsequent selection phase, articles were excluded if they did not contain information on RF for DDIs. The outcome of interest was the pharmacological RF for DDIs (or grouped by severity) between ART and non-ART in PLWH ≥18 years. Data was synthesised narratively.
Results 349 articles were identified and 10 included (4 longitudinal and 6 cross-sectional). Kunimoto-et-al, found an association between the occurrence of potential DDIs and number of comedications(OR=1.52[1.16–1.99]), similar correlation was reported by Okoli-et-al(OR=1.3[1.2–1.3]), Pontelo-et-al(OR=1.13[1.11–1.15]) and Bastida-et-al(OR=1.18[1.14-1.22]). El Moussaoui-et-al found that the number of comedications independently associated with orange-(OR=1.8[1.6–2.0]) and red-flag(OR=1.4[1.3–1.6]) DDIs. Related to comedication, Kunimoto-et-al found polypharmacy as a severe RF for DDIs(OR=11.69[3.01–45.40]), this also reported by López-Centeno-et-al for red-(OR=2.65[1.98–3.54]) and orange-flag(OR=2.17[1.90–2.47]) DDIs. Halloran-et-al reported that ART-regimens containing protease inhibitors (PIs) were more likely to have DDIs compared with those containing non-nucleoside reverse transcriptase inhibitors(NNRTI)- and integrase inhibitors(II). This increased risk of IP-regimens was also notified by Chen-et-al(OR=2.54[1.25-5.16]) and Bastida-et-al(OR=1.18[1.14-1.22]), instead Fernández Cañabate-et-al found it in PI-regimens(OR=8.82[4.07–19.14]) as also NNRTI-regimens(OR=2.65[1.25–5.16]). Moreover, El Moussaoui-et-al found PIs as an independent RF for red-(OR=7.9[3.2-19.5]) and orange-flag(OR=7.5[4.5-12.5]) DDIs while NNRTI(OR=2.4[1.5-4.0]) and the II(OR=1.6[1.0-2.6]) only it were for orange-flag. This risk of PIs of were more involved in red-flag/contraindicated was also reported by López-Centeno-et-al and Holtzman-et-al.
Conclusion and Relevance This is the first systematic review summarising literature in this field and is helpful to stratify patients at need for specialised management to reduce DDIs and polypharmacy burden.
Conflict of Interest No conflict of interest