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Drug Interaction Rate No Higher With HIV
Than Without in French Group Over 60
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2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore, Maryland
Mark Mascolini
Drug-drug interactions rates did not differ significantly between HIV-positive people over 60 years old and their contemporaries without HIV, according to results of recall-based prospective 6-month comparison in France [1].
This finding must be interpreted cautiously, however, because the HIV and non-HIV groups were not matched for age, gender, or non-HIV disease burden. Although non-HIV disease rates were high in both groups, they were consistently higher in the non-HIV group, almost all of whom had cardiovascular disease or hypertension. And the non-HIV group used more nonantiretrovirals (non-ARVs) than the HIV group.
The 236 people with HIV and 120 without HIV completed questionnaires about their diseases and the drugs they took regularly. Researchers in Marseille analyzed drug interactions according to the French drug agency by using the tool available at www.theriaque.org.
HIV-positive people were cared for in specialized hospital wards and offices of HIV physicians in the area, while people without HIV were mostly outpatients seen in clinics. Both groups were receiving care in 2009. Age averaged 67 in the HIV group and 71 in the non-HIV group, and the non-HIV group had a significantly higher proportion older than 65 (81% versus 53%, P < 10(5)). The HIV group included a significantly lower proportion of women than the non-HIV group (20% versus 56%, P < 10(5)).
Substantially lower proportions of people with than without HIV had cardiovascular disease or hypertension (47% versus 98.3%), pain symptoms (24.6% versus 35.8%), digestive disorders (22.9% versus 34.2%), arthritis (21.2% versus 45%), diabetes (13.6% versus 19.1%), and osteoporosis (9.3% versus 18.3%). A robust 16 people in the HIV group (6.8%) reported no disease besides HIV, while everyone in the HIV-negative group had some clinical condition.
Almost everyone with HIV (93%) and without HIV (99%) reported using non-ARVs, though average non-ARV number was significantly higher in the non-HIV group than the HIV group (5.6 versus 4.9, P < 0.05). In both groups, acetaminophen was the most used non-ARV, taken by 29% with HIV and 53% without HIV. Among people with HIV, other frequently used drugs were lysine acetyl salicylate (intravenous aspirin, 14%), the benzodiazepine bromazepam (10%), rosuvastatin (10%), and the antiplatelet clopidogrel (8%). In the non-HIV group, other frequently used drugs were the antihypertensive irbesartan (15%), the antihypertensive hydrochlorothiazide (13%), metformin (13%), and clopidogrel (9%).
Ninety-five people with HIV (40%) and 49 without HIV (41%) had clinically relevant drug interactions. However, people with HIV had 5 contraindicated drug interactions, compared with 1 in the non-HIV group. The contraindicated interactions in the HIV group involved ritonavir plus alfusozine (for urinary retention) and a protease inhibitor plus simvastatin. None of these interactions had a clinical impact.
The researchers suggested that, with careful planning and close monitoring, non-ARVs can be prescribed without major interactions in elderly HIV-positive people.
Reference
1. Enel P, Retornaz F, Philibert P, et al. HIV-infected and non HIV-infected elderly patients: do their drug interactions differ? 2nd International Workshop on HIV and Aging, October 27-28, 2011. Baltimore, Maryland. Abstract P_06.
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