title: Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria.
abstract: BACKGROUND
  Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria.
  
  
  METHODS
  The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination).
  
  
  RESULTS
  Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs.
  
  
  CONCLUSIONS
  There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.
authors.affiliation: Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
authors.forename: Kazeem A
authors.initials: KA
authors.lastname: Oshikoya
authors.affiliation: Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Oreagba
authors.affiliation: Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Saheed
authors.initials: S
authors.lastname: Lawal
authors.affiliation: Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Olufunsho
authors.initials: O
authors.lastname: Awodele
authors.affiliation: Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
authors.forename: Olayinka O
authors.initials: OO
authors.lastname: Ogunleye
authors.affiliation: Department of Paediatrics, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
authors.forename: Idowu O
authors.initials: IO
authors.lastname: Senbanjo
authors.affiliation: Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Sunday O
authors.initials: SO
authors.lastname: Olayemi
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Veronica C
authors.initials: VC
authors.lastname: Ezeaka
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Edamisan O
authors.initials: EO
authors.lastname: Temiye
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Titilope A
authors.initials: TA
authors.lastname: Adeyemo
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Pharmacy, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria.
authors.forename: Oluranti
authors.initials: O
authors.lastname: Opanuga
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Olufunmilayo A
authors.initials: OA
authors.lastname: Lesi
authors.affiliation: APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: Sulaimon A
authors.initials: SA
authors.lastname: Akanmu
keywords: antiretroviral drug; co-prescribed drug; contraindication; infection; prevalence; therapy modification; therapy monitoring
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