Higher plasma drug levels in elderly people living with HIV treated with darunavir

• Published in: PloS one 2021-02, Vol.16 (2), p.e0246171
• Main Authors: Tyrberg, Erika, Edén, Arvid, Eriksen, Jaran, Nilsson, Staffan, Treutiger, Carl Johan, Thalme, Anders, Mellgren, Åsa, Gisslén, Magnus, Andersson, Lars-Magnus
• Format: Article
• Language: English
• Subjects: adherence; Age; Aged patients; Antiretroviral agents; Antiretroviral drugs; antiretroviral medications; Antiretroviral therapy; Biology and Life Sciences; Care and treatment; Chromatography; Clinical Medicine; Complications and side effects; Darunavir; Demographic aspects; Diagnosis; Dosage and administration; Drug dosages; Drug interactions; Drug therapy; Editing; Efavirenz; Funding; Health risks; High performance liquid chromatography; High pressure; HIV; HIV infection; Hospitals; Human immunodeficiency virus; individuals; infection; Infectious diseases; Integrase; Klinisk medicin; Laboratories; Life expectancy; Life span; Liquid chromatography; Medicin och hälsovetenskap; Medicine and Health Sciences; Nucleosides; older; Older people; People and Places; Pharmacology; Plasma; polypharmacy; population; Prescription drugs; Protease inhibitors; Proteinase inhibitors; Public health; Questionnaires; Reviews; risk; Risk factors; Science & Technology - Other Topics; survival
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246171

The proportion of elderly people living with HIV-1 (PLHIV) is rising. In older patients, comorbidities and concomitant medications are more frequent, increasing the risk of potential drug-drug interactions (PDDIs). Data on the pharmacokinetics of ART in individuals aged ≥ 65 years of age are scarce. We compared plasma drug levels of ART, PDDIs, and side-effects in PLHIV aged ≥ 65 years of age, with controls ≤ 49 years of age. Patients ≥ 65 years of age and controls ≤ 49 years of age, all of whom were on stable treatment with atazanavir (ATV), darunavir (DRV), or efavirenz (EFV) were included cross-sectionally. Plasma drug levels of ART were analyzed, comorbidities, concomitant medication, adherence, and side-effects recorded, and PDDIs analyzed using drug interactions databases. Between 2013 and 2015, we included 100 individuals ≥ 65 years of age (study group) and 99 controls (≤ 49 years of age). Steady-state DRV concentrations were significantly higher in the study group than in the control group (p = 0.047). In the ATV group there was a trend towards a significant difference (p = 0.056). No significant differences were found in the EFV arm. The DRV arm had a higher frequency of reported side-effects than the ATV and EFV arms in the study group (36.7% vs. 0% and 23.8% respectively (p = 0.014), with significant differences between DRV vs. ATV, and EFV vs. ATV). Higher steady-state plasma levels of DRV and ATV (but not EFV) were found in PLHIV aged ≥ 65 years of age, compared to controls ≤ 49 years of age.