Polypharmacy, anticholinergic burden and drug–drug interaction assessment in people with four-class-resistant HIV: data from the PRESTIGIO registry
- Autori: Mazzitelli, M.; Pontillo, D.; Clemente, T.; Di Biagio, A.; Cenderello, G.; Rusconi, S.; Menzaghi, B.; Fornabaio, C.; Garlassi, E.; Zazzi, M.; Castagna, A.; Cattelan, A.M.; Null, N.; Castagna, A.; Spagnuolo, V.; Galli, L.; Maggiolo, F.; Calza, L.; Focà, E.; Lagi, F.; Cenderello, G.; Di Biagio, A.; Marchetti, G.; Rusconi, S.; Cervo, A.; Gagliardini, R.; Bonora, S.; Cattelan, A.M.; Zazzi, M.; Santoro, M.M.; Zazzi, M.; Santoro, M.M.; Galli, A.; Saladini, F.; Armenia, D.; Carini, E.; Bagaglio, S.; Galli, L.; Lolatto, R.; Diotallevi, S.; Tavio, M.; Paggi, A.M.; Ripoli, B.A.; Vichi, F.; Bellucci, A.; Mirabelli, E.; Saracino, A.; Balena, F.; Maggiolo, F.; Comi, L.; Valenti, D.; Suardi, C.; Calza, L.; Malerba, F.; Castelli, F.; Focà, E.; Minisci, D.; Pennati, F.; Celotti, A.; Brognoli, F.; Menzaghi, B.; Farinazzo, M.; Cacopardo, B.; Celesia, B.M.; Raddusa, M.S.P.; Giarratana, C.; Torti, C.; Fusco, P.; Bruno, G.; Pan, A.; Brambilla, P.; Fornabaio, C.; Bartoloni, A.; Giachè, S.; Corsi, P.; Kiros, S.T.; Lagi, F.; Ducci, F.; Santantonio, T.; Caputo, S.L.; Ferrara, S.; Narducci, M.; Pontali, E.; Feasi, M.; Sarà, A.; Bassetti, M.; Di Biagio, A.; Blanchi, S.; Castagna, A.; Spagnuolo, V.; Carini, E.; Bagaglio, S.; Galli, L.; Lolatto, R.; Galli, A.; Clemente, T.; Borjesson, R.P.; Diotallevi, S.; Antinori, S.; Formenti, T.; Giacomelli, A.; Marchetti, G.; Gazzola, L.; De Flaviis, F.; Puoti, M.; Moioli, C.; D'Amico, F.; Mussini, C.; Cervo, A.; Enrica, R.; Giulia, N.; Beghetto, B.; Manzillo, E.; Lanzardo, A.; Cattelan, A.M.; Mazzitelli, M.; Cascio, A.; Trizzino, M.; Fronti, E.; Laccabue, D.; Gulminetti, R.; Zuccarini, A.; Francisci, D.; Schiaroli, E.; De Socio, G.; Garlassi, E.; Corsini, R.; Gagliardini, R.; Fusto, M.; Sarmati, L.; Malagnino, V.; Lamonica, S.; Di Giambenedetto, S.; Mulas, T.; Cenderello, G.; Pincino, R.; Tumbarello, M.; Fabbiani, M.; Panza, F.; Rancan, I.; Di Perri, G.; Bonora, S.; Ferrara, M.; Fantino, S.; Malena, M.; Fiscon, M.
- Anno di pubblicazione: 2024
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/665599
Abstract
Objectives: To evaluate polypharmacy, anticholinergic burden (ACB) and drug-drug interactions (DDIs) in people with four-class-resistant HIV (4DR-PWH). Methods: We performed a cross-sectional study, including 4DR-PWH from the PRESTIGIO Registry taking at least one non-antiretroviral drug. Polypharmacy was defined as taking five or more non-antiretroviral drugs. ACB was calculated using the ACB scale: 0=no AC effect, 1-2=low/moderate risk, ≥3=high AC risk. Participants' characteristics by ACB score were compared using the Kruskal-Wallis test, and Spearman's correlation coefficient was used to assess linear relationships. DDIs were evaluated using the Liverpool database. Results: Overall, 172 4DR-PLWH were evaluated: 75.6% males, median age 49.9 years (IQR=45.6-56), 62 (27.1%) on polypharmacy, 124 (72.1%) using a boosting agent and 72 (41.8%) with four or more antiretrovirals. Based on ACB, 128 (74.45%), 33 (19.2%) and 11 (6.4%) had a no, low/moderate and high AC risk, respectively. The most common AC drugs were β-blockers (12.2%), diuretics (8.7%) and antidepressants (8.7%). The high ACB was significantly related to the number of drugs/person (r=0.33, P<0.0001) and the number of clinical events (r=0.222, P=0.004). Overall, 258 DDIs were found between antiretrovirals and co-medications in 115 (66.8%) PWH, and 14 (8.1%) PWH received contraindicated drug combinations. Conclusions: In 4DR-PWH, polypharmacy, DDIs and the proportion of people with moderate/high AC burden were high. In 4DR-PWH undetectability achievement and maintenance is the priority and use of boosted PIs is common. A strict collaboration (infectious diseases specialists, virologists, pharmacologists) is needed to limit the risk of ACB and DDIs and to explore the advantages of new antiretrovirals.