Abstract

Background

The extent to which drug–drug interactions (DDIs) between antiretrovirals (ARVs) and co-medications are recognized and managed has not been thoroughly evaluated in limited-resource settings.

Objectives

This prospective questionnaire-based study aimed to determine the prevalence and risk factors for unrecognized/incorrectly managed DDIs in people living with HIV followed-up at the Chronic Diseases Clinic of Ifakara (CDCI) and enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).

Methods

We prospectively included ARV-treated adults receiving ≥1 co-medication coming for a follow-up visit at the CDCI between March and July 2017. Using a structured questionnaire, physicians were requested to identify potentially clinically significant DDIs in the prescribed treatment, to provide recommendations for their management and to indicate any hurdles to implement the recommendations. Prescriptions were subsequently screened for DDIs using the Liverpool DDIs database. Identified clinically significant DDIs and their recommended management according to the DDIs database were compared with the information provided in the questionnaires.

Results

Among 334 participants, the median age was 47 years (IQR = 40–56 years), 69% were female and 82% had ≥1 non-communicable disease (NCD). Overall, 129 participants had ≥1 clinically relevant DDI, which was not recognized and/or incorrectly managed in 56 participants (43%). Of those, 6 (11%) were due to limited monitoring options or medication affordability issues. In the multivariable logistic regression, the presence of ≥1 NCD was associated with an increased risk for unrecognized/incorrect DDI management (OR = 15.8; 95% CI = 1.8–139.6).

Conclusions

Recognition/appropriate management of DDIs is suboptimal, highlighting the need for educational programmes, pharmacovigilance activities and increased access to medications and monitoring options. This should become a focus of HIV programmes given the increasing burden of NCDs in sub-Saharan Africa.

中文翻译：

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识别和管理坦桑尼亚农村艾滋病毒感染者队列中抗逆转录病毒药物和联合用药之间具有临床意义的药物相互作用：一项基于问卷的前瞻性研究

摘要

背景

在资源有限的环境中，抗逆转录病毒药物 (ARV) 和联合用药之间的药物相互作用 (DDI) 得到认可和管理的程度尚未得到彻底评估。

目标

这项基于问卷的前瞻性研究旨在确定在 Ifakara 慢性病诊所 (CDCI) 随访并参加 Kilombero 和 Ulanga 抗逆转录病毒队列 (KIULARCO) 的 HIV 感染者中未被识别/管理不当的 DDI 的患病率和风险因素.

方法

我们前瞻性地纳入了接受 ≥ 1 种联合用药的 ARV 治疗成人，在 2017 年 3 月至 7 月期间在 CDCI 进行随访。使用结构化问卷，要求医生确定处方治疗中可能具有临床意义的 DDI，以提供管理建议，并指出实施建议的任何障碍。随后使用利物浦 DDI 数据库对处方进行 DDI 筛选。将根据 DDI 数据库确定的具有临床意义的 DDI 及其推荐管理与问卷中提供的信息进行比较。

结果

在 334 名参与者中，中位年龄为 47 岁（IQR = 40-56 岁），69% 为女性，82% 患有≥1 种非传染性疾病 (NCD)。总体而言，129 名参与者有≥1 项临床相关的 DDI，56 名参与者 (43%) 未被识别和/或管理不当。其中，6 (11%) 是由于有限的监测选项或药物负担能力问题。在多变量逻辑回归中，≥1 NCD 的存在与未识别/不正确 DDI 管理的风险增加相关（OR = 15.8；95% CI = 1.8–139.6）。

结论

DDI 的识别/适当管理是次优的，突出了教育计划、药物警戒活动以及增加获得药物和监测选项的必要性。鉴于撒哈拉以南非洲非传染性疾病负担日益加重，这应该成为艾滋病毒项目的重点。