Prevalence and correlates of drug-drug interactions in people with HIV on antiretroviral therapy in the post-pandemic era

HIV infection affects a significant number of people worldwide. Timely initiation of antiretroviral treatment has changed HIV infection to a chronic condition and plays a critical role in illness management. HIV attacks the host's immune system, primarily affecting CD4+ T-lymphocytes. The progression of HIV infection, the rising life expectancy of people with HIV, and the prevalence of comorbidities and polypharmacy complicate treatment and raise the risk of drug-drug interactions. The present study is a retrospective study conducted in a reference hospital for HIV infection. It aimed to calculate the rate of interactions between antiretroviral treatment and non-antiretroviral medication received by participants due to comorbidities. Also, the rate of interactions between non-antiretroviral medications was calculated. Age, polypharmacy, and medication pharmacokinetic features were investigated as risk factors for interactions. The total number was 804 people with HIV on antiretroviral therapy. 412 participants were receiving non-antiretroviral therapy, of whom approximately 40% experienced interactions, a lower rate compared to similar studies. Also, most participants were receiving antiretroviral treatment that included the combination of integrase inhibitors (boosted or not) with two nucleotide reverse transcriptase inhibitors. Regarding the co-administered drugs, most of them belonged to the categories acting on the cardiovascular and nervous systems. It was observed that specific classes of antiretroviral and non-antiretroviral drugs were associated with higher rates of interactions. More specifically, the co-administration of boosted antiretroviral treatment (protease inhibitors or integrase inhibitors) with drugs for cardiovascular and nervous system disorders frequently results in interactions. Most of the observed interactions were classified as moderate risk, while less than 3% of participants were taking a contraindicated combination. In addition, almost half of the participants receiving concomitant medication experienced interactions between non-antiretroviral drugs. In conclusion, the study highlighted the importance of evaluating potential drug interactions in people with HIV on antiretroviral therapy. To conclude, understanding the pharmacokinetic properties of drugs, the use of specialized databases, and collaboration between physicians of different specialties and pharmacists can help to optimize treatment protocols and improve healthcare for people with HIV.