title: Managing potential drug-drug interactions between gastric acid-reducing agents and antiretroviral therapy: experience from a large HIV-positive cohort.
abstract: Drug-drug interactions between antiretroviral therapy and other drugs are well described. Gastric acid-reducing agents are one such class. However, few data exist regarding the frequency of and indications for prescription, nor risk assessment in the setting of an HIV cohort receiving antiretroviral therapy. To assess prevalence of prescription of gastric acid-reducing agents and drug-drug interaction within a UK HIV cohort, we reviewed patient records for the whole cohort, assessing demographic data, frequency and reason for prescription of gastric acid-reducing therapy. Furthermore, we noted potential drug-drug interaction and whether risk had been documented and mitigated. Of 701 patients on antiretroviral therapy, 67 (9.6%) were prescribed gastric acid-reducing therapy. Of these, the majority (59/67 [88.1%]) were prescribed proton pump inhibitors. We identified four potential drug-drug interactions, which were appropriately managed by temporally separating the administration of gastric acid-reducing agent and antiretroviral therapy, and all four of these patients remained virally suppressed. Gastric acid-reducing therapy, in particular proton pump inhibitor therapy, appears common in patients prescribed antiretroviral therapy. Whilst there remains a paucity of published data, our findings are comparable to those in other European cohorts. Pharmacovigilance of drug-drug interactions in HIV-positive patients is vital. Education of patients and staff, and accurate data-gathering tools, will enhance patient safety.
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Lewis
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Stott
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: Monnery
authors.affiliation: Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, UK.
authors.forename: K
authors.initials: K
authors.lastname: Seden
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Beeching
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Chaponda
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, UK.
authors.forename: S
authors.initials: S
authors.lastname: Khoo
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool, UK mikebeadsworth@yahoo.com.
authors.forename: M B J
authors.initials: MB
authors.lastname: Beadsworth
mesh_terms: D000863:Antacids / Q000493:pharmacokinetics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D000863:Antacids; D017320:HIV Protease Inhibitors; D054328:Proton Pump Inhibitors
keywords: AIDS; HIV; acid reducing therapy; antiretroviral therapy; drug-drug interactions; protease inhibitors; proton pump inhibitors; treatment