Management of drug interactions with direct‐acting antivirals in Dutch HIV/hepatitis C virus‐coinfected patients: adequate but not perfect

• Published in: HIV medicine 2018-03, Vol.19 (3), p.216-226
• Main Authors: Rijnders, B, Valk, M, Burger, DM, Meer, J. T. M., Nellen, F. J. B., Pajkrt, D., Goorhuis, A., Hovius, J. W., Eden, J., Back, N. K. T., Berkhout, B., Cornelissen, M. T. E., Wintermans, B., Ziekenhuis, Catharina, Beek, E., Jansz, A. R., Tjhie, J., Brouwer, A. E., Erve, R., Keelan‐Pfaf, S., Buiting, A. G. M., Kinderziekenhuis, Emma, Plas, A., Gorp, E. C. M., Beek, J. E. A., Vriesde, M., Zonneveld, L. M., Berg‐Cameron, H. J., Pas, S. D., Elsenburg, L. J. M., Kwa, I. S., Groeneveld, P. H. P., Berg, J. F., Bliek, G. L., Bor, P. C. J., Bloembergen, P., Boer, M. G. J., Jolink, H., Claas, E. C. J., Hollander, J. G., Kastelijns, M., Smit, J. V., Struik‐Kalkman, D., Tearno, C., Loo, I. H. M., Hartingsveld, A. Y., Mutsaers, J. A. E. M., Veen, S. Q., Slotervaart, MC, Vlasblom, D. J., Smits, P. H. M., Houte, D. P. F., Kampschreur, L. M., Kootstra, G. J., Kortmann, W., Cohen Stuart, J. W. T., Diederen, B. M. W., Renckens, R., Blok, W. L., Brouwer, C. J., Geerders, G. F., Kleene, M. J., Meché, I. B., Spelbrink, M., Crevel, R., Ven, A. J. A. M., Rahamat‐Langendoen, J., Swanink, C. M. A., Lelyveld, S. F. L., Soetekouw, R., Prijt, L. M. M., Swaluw, J., Verhagen, D. W. M., Wijk, M., Bakker, M., Kleinnijenhuis, J., Kloeze, E., Vermont, C. L., Boonstra, A., Leer‐Buter, C. C., Oosterheert, J. J., Agtmael, M. A., Bomers, M., Heitmuller, M., Laan, L. M., Ang, C. W., Houdt, R., Pettersson, A. M., Wolfs, T. F. W., Nauta, N., Bezemer, D. O., Sighem, A. I., Boender, T. S., Zaheri, S., Bakker, Y., Koops, J., Kruijne, E., Munjishvili, L., Ruijs, Y., Rutkens, T.
• Format: Article
• Language: English
• Subjects: Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Antiviral Agents - pharmacology; Antiviral Agents - therapeutic use; Chronic infection; Coinfection - drug therapy; combination antiretroviral therapy; co‐medication; direct‐acting antivirals; Drug Interactions; Drugs; drug–drug interactions; Female; Hepacivirus - drug effects; Hepatitis; Hepatitis C; Hepatitis C - drug therapy; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Male; Medical personnel; Middle Aged; Netherlands; Observational Studies as Topic; Patients; Physicians; Practice Patterns, Physicians; Prospective Studies; Retrospective Studies; Sustained Virologic Response; Therapy; Viruses
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12570

Objectives Direct‐acting antivirals (DAAs) for treatment of chronic hepatitis C virus (HCV) infection can cause drug–drug interactions (DDIs) with combination antiretroviral therapy (cART) and non‐cART co‐medication. We mapped how physicians manage DDIs between DAAs and co‐medication and analysed treatment outcomes. Methods Data were prospectively collected as part of the ATHENA HIV observational cohort and retrospectively analysed. Dutch patients with HIV/HCV coinfection who initiated treatment with DAAs between January 2015 and May 2016 were included. Co‐medication 3 months prior to and during DAA therapy was identified. Potential DDIs with the DAAs were checked using http://hep-druginteractions.org. DDIs were categorized as: (1) no interaction expected; (2) potential interaction; (3) contra‐indication; (4) no recommendation. These categories were used to determine which patients switched or had a DDI during DAA therapy with co‐medication. Results A total of 423 patients were treated with DAAs, of whom 418 (99%) used cART and 251 (59%) used non‐cART co‐medication. Before commencing DAA treatment, in 17 of 84 (20%) patients the non‐cART co‐medication which could result in a category 2/3 DDI was discontinued before DAA initiation, including two of six (33%) prescriptions of category 3 drugs. A total of 196 of 418 (47%) patients had a category 2/3 DDI between their DAA regimen and cART. Category 2/3 DDIs were prevented by switching cART in 78 of 147 (53%) and 47 of 49 (98%) patients. Overall, 367 of 423 (87%) patients have achieved a sustained virological response (33 in follow‐up). Conclusions Prescription patterns suggest that physicians are aware of potential DDIs between co‐medication and DAAs, in particular potential DDIs with cART. Greater awareness is needed concerning category 3 interactions between non‐cART co‐medication and DAAs.