Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda.
Background: Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of...
| Publicado en: | BMC Infectious Diseases Vol. 20; no. 1; pp. 1 - 15 |
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| Autores principales: | , , , , , , |
| Formato: | Journal Article |
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BioMed Central
8/5/2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=144981293&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 144981293 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712334 1CHU jtl: BMC Infectious Diseases issn: 14712334 maglogo: N pubinfo: dt: 8/5/2020 vid: 20 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 144981293 144981293 NLM32758158 10.1186/s12879-020-05296-w NLM32758158 144981293 ppf: 1 ppct: 14 formats: tig: atl: Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda. aug: au: Eneh, Prosperity C. Hullsiek, Katherine Huppler Kiiza, Daniel Rhein, Joshua Meya, David B. Boulware, David R. Nicol, Melanie R. affil: Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA sug: subj: HIV-1 Antifungal Agents Therapeutic Use Hospitalization Anti-Retroviral Agents Therapeutic Use AIDS-Related Opportunistic Infections Drug Therapy Meningitis, Cryptococcal Drug Therapy Cryptococcus Coinfection Drug Therapy Young Adult Middle Age Uganda Coinfection Retrospective Design Treatment Outcomes Male Adolescence Female Adult Drug Interactions Risk Factors Prevalence Drug Monitoring Methods Meningitis, Cryptococcal Diagnosis Meningitis, Cryptococcal Microbiology AIDS-Related Opportunistic Infections Scales Middle Aged: 45-64 years Adolescent: 13-18 years Adult: 19-44 years Male Female ab: Background: Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis.Methods: In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed.Results: In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations.Conclusions: The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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