Key result
Reduced-dose apixaban successfully prevents thromboembolism in 6 patients on boosted antiretroviral therapy.
Why the study?
The potential for drug-drug interactions between direct oral anticoagulants and ritonavir- or cobicistat-boosted antiretroviral therapy is vast, with limited data on apixaban use.
Does reduced-dose apixaban safely treat and prevent thromboembolic complications in persons living with HIV on ritonavir- or cobicistat-boosted ART?
Case Report (n=6)
Does reduced-dose apixaban safely treat and prevent thromboembolic complications in persons living with HIV on ritonavir- or cobicistat-boosted ART?
Reduced-dose apixaban can be successfully used to manage thromboembolic complications in HIV patients on ritonavir- or cobicistat-boosted ART, mitigating the risk of major drug-drug interactions.
May guide individualized dosing in select cases; hypothesis-generating and should not change practice without prospective data.
The potential for drug-drug interactions (DDIs) between direct oral anticoagulants and antiretroviral therapy (ART) is vast. Ritonavir and cobicistat are used as pharmacokinetic enhancers with either concurrent protease inhibitors or the integrase strand transfer inhibitor, elvitegravir, to optimize therapeutic concentrations by cytochrome P450 (CYP) inhibition. To date, only rivaroxaban and dabigatran have reported cases of use with ritonavir-boosted ART. Apixaban is metabolized similarly to rivaroxaban, but offers a dose reduction in the case of major DDIs. We report the successful use of reduced-dose apixaban to treat and prevent thromboembolic complications in six persons living with human immunodeficiency virus (HIV) on ritonavir- or cobicistat-boosted ART. This case series and available literature support the use of apixaban or dabigatran, depending on the boosted ART regimen.
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Nisly et al. (2019) conducted a case report in Human immunodeficiency virus (HIV) requiring anticoagulation (n=6). Reduced-dose apixaban was evaluated on Successful treatment and prevention of thromboembolic complications. Reduced-dose apixaban was successfully used to treat and prevent thromboembolic complications in six patients with HIV on ritonavir- or cobicistat-boosted ART.
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