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Recognition and management of clinically significant drug-drug interactions between antiretrovirals and co-medications in a cohort of people living with HIV in rural Tanzania: a prospective questionnaire-based study.
Kuemmerle, Andrea; Sikalengo, George; Vanobberghen, Fiona; Ndege, Robert C; Foe, Gideon; Schlaeppi, Chloé; Burri, Christian; Battegay, Manuel; Paris, Daniel H; Glass, Tracy R; Weisser, Maja; Marzolini, Catia.
Affiliation
  • Kuemmerle A; Swiss Tropical and Public Health Institute, Basel, Switzerland.
  • Sikalengo G; University of Basel, Basel, Switzerland.
  • Vanobberghen F; Ifakara Health Institute, Ifakara, Tanzania.
  • Ndege RC; Swiss Tropical and Public Health Institute, Basel, Switzerland.
  • Foe G; University of Basel, Basel, Switzerland.
  • Schlaeppi C; Ifakara Health Institute, Ifakara, Tanzania.
  • Burri C; Saint Francis Referral Hospital, Ifakara, Tanzania.
  • Battegay M; University of Basel, Basel, Switzerland.
  • Paris DH; Swiss Tropical and Public Health Institute, Basel, Switzerland.
  • Glass TR; University of Basel, Basel, Switzerland.
  • Weisser M; University of Basel, Basel, Switzerland.
  • Marzolini C; Department of Infectious Diseases & Hospital Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
J Antimicrob Chemother ; 76(10): 2681-2689, 2021 09 15.
Article in En | MEDLINE | ID: mdl-34337653
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.
Subject(s)

Full text: 1 Collection: 01-internacional Health context: 1_ASSA2030 Database: MEDLINE Main subject: Pharmaceutical Preparations / HIV Infections Type of study: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Limits: Adult / Female / Humans / Middle aged Country/Region as subject: Africa Language: En Journal: J Antimicrob Chemother Year: 2021 Document type: Article

Full text: 1 Collection: 01-internacional Health context: 1_ASSA2030 Database: MEDLINE Main subject: Pharmaceutical Preparations / HIV Infections Type of study: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Limits: Adult / Female / Humans / Middle aged Country/Region as subject: Africa Language: En Journal: J Antimicrob Chemother Year: 2021 Document type: Article