1. Management of drug interactions with direct-acting antivirals in Dutch HIV/hepatitis C virus-coinfected patients
- Author
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Smolders, E.J., Smit, C., Kanter, C.T.M.M. de, Dofferhoff, A.S.M., Arends, J.E., Brinkman, K., Reiss, P., Crevel, R. van, Keuter, M., Ven, A.J.A.M. van der, Hofstede, H.J.M. ter, Albers, M.A., Grintjes‐Huisman, K.J.T., Marneef, M., Hairwassers, A., Rahamat-Langendoen, J.C., Burger, D.M., Internal Medicine, Medical Microbiology & Infectious Diseases, Virology, Pediatrics, Infectious diseases, AII - Infectious diseases, AII - Amsterdam institute for Infection and Immunity, APH - Aging & Later Life, Global Health, Paediatric Infectious Diseases / Rheumatology / Immunology, Center of Experimental and Molecular Medicine, APH - Quality of Care, APH - Global Health, Medical Microbiology and Infection Prevention, APH - Health Behaviors & Chronic Diseases, Other departments, Paediatric Gastroenterology, ARD - Amsterdam Reproduction and Development, APH - Digital Health, APH - Personalized Medicine, Internal medicine, and Microbes in Health and Disease (MHD)
- Subjects
Male ,drug-drug interactions ,Sustained Virologic Response ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,HIV Infections ,Hepacivirus ,medicine.disease_cause ,0302 clinical medicine ,immune system diseases ,Drug Interactions ,Pharmacology (medical) ,Prospective Studies ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Netherlands ,media_common ,Coinfection ,Health Policy ,virus diseases ,Hepatitis C ,Middle Aged ,Observational Studies as Topic ,Infectious Diseases ,Cohort ,combination antiretroviral therapy ,Female ,030211 gastroenterology & hepatology ,Drug ,Cart ,medicine.medical_specialty ,Hepatitis C virus ,media_common.quotation_subject ,Antiviral Agents ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,SDG 3 - Good Health and Well-being ,Internal medicine ,medicine ,Humans ,Medical prescription ,direct-acting antivirals ,Retrospective Studies ,business.industry ,HIV ,medicine.disease ,co-medication ,Regimen ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,drug–drug interactions ,hepatitis C ,business - Abstract
Objectives: Direct-acting antivirals (DAAs) for treatment of chronic hepatitis C virus (HCV) infection can cause drug–drug interactions (DDIs) with combination antiretroviral therapy (cART) and non-cART co-medication. We mapped how physicians manage DDIs between DAAs and co-medication and analysed treatment outcomes.Methods: Data were prospectively collected as part of the ATHENA HIV observational cohort and retrospectively analysed. Dutch patients with HIV/HCV coinfection who initiated treatment with DAAs between January 2015 and May 2016 were included. Co-medication 3 months prior to and during DAA therapy was identified. Potential DDIs with the DAAs were checked using http://hep-druginteractions.org. DDIs were categorized as: (1) no interaction expected; (2) potential interaction; (3) contra-indication; (4) no recommendation. These categories were used to determine which patients switched or had a DDI during DAA therapy with co-medication.Results: A total of 423 patients were treated with DAAs, of whom 418 (99%) used cART and 251 (59%) used non-cART co-medication. Before commencing DAA treatment, in 17 of 84 (20%) patients the non-cART co-medication which could result in a category 2/3 DDI was discontinued before DAA initiation, including two of six (33%) prescriptions of category 3 drugs. A total of 196 of 418 (47%) patients had a category 2/3 DDI between their DAA regimen and cART. Category 2/3 DDIs were prevented by switching cART in 78 of 147 (53%) and 47 of 49 (98%) patients. Overall, 367 of 423 (87%) patients have achieved a sustained virological response (33 in follow-up).Conclusions: Prescription patterns suggest that physicians are aware of potential DDIs between co-medication and DAAs, in particular potential DDIs with cART. Greater awareness is needed concerning category 3 interactions between non-cART co-medication and DAAs.
- Published
- 2018