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Relationship between Contraindicated Drug-Drug Interactions and Subsequent Hospitalizations among Patients Living with HIV Initiating Combination Antiretroviral Therapy.

  • Author(s): Sangiovanni, Ryan J
  • Jakeman, Bernadette
  • Nasiri, Mona
  • Ruth, Lindsey
  • Mahatme, Sheran
  • Patel, Nimish
  • et al.
Abstract

People living with HIV (PLWH) are at an increased risk of contraindicated drug-drug interactions (XDDIs), which may result in deleterious outcomes. Study objectives were to: 1) compare the frequency of hospitalizations between patients with and without XDDIs and 2) determine if XDDIs are independently associated with hospitalizations in PLWH. A retrospective cohort study was performed among PLWH receiving care at the Upstate New York Veterans' Healthcare Administration or University of New Mexico Truman Health Services from 2000-2013. Hospitalization was defined as an admission to an inpatient hospital facility for ≥ 24 hours. Of the 1329 patients evaluated, 149 (11.2%25) patients were hospitalized within one year of ART initiation. A significantly higher proportion of patients with XDDIs were hospitalized compared to those who did not have XDDIs (20.3%25 versus 10.2%25, Risk Ratio, RR: 1.98, 95%25 confidence interval, CI: 1.35-2.91, p=0.001). In the multivariate Cox proportional hazards regression analyses, XDDIs were independently associated with hospitalizations (hazard ratio [HR]: 1.58; 95%25 CI: 1.00-2.48; p=0.05), after adjustment for CD4<242 cells/mm3 (HR: 2.38; 95%25 CI: 1.72-3.33; p<0.001), protease inhibitor (PI)-based regimen (HR: 1.35; 95%25 CI: 0.97-1.89; p=0.08), recreational drug use (HR: 2.58, 95%25 CI: 1.85-3.58, p<0.001) and non-HIV medications ≥10 (HR: 1.62; 95%25 CI: 0.97-2.69; p=0.07). In this study an increased risk of hospitalization was observed among PLWH with XDDIs compared to those without XDDIs. This relationship persisted after adjustment for CD4 count, use of a PI-based regimen, recreational drug use and number of non-HIV medications.

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