Antiretrovirals and frequently prescribed medications in peopliving with HIV: Potential drug-drug interactions detected by three online-databases

Background: Since the advent of antiretroviral therapy, HIV infection, which was once considered a life-threatening condition, can now be managed as a chronic disease. People infected with HIV have high prevalence rates of comorbid illnesses, including cardiovascular diseases, cancers, diabetes, dyslipidemia, chronic renal disease, and chronic liver disease. Comedication of antiretrovirals and frequently prescribed medications for comorbid illness could cause serious drug-drug interactions (DDIs). Objective: To evaluate the level of agreement among the drug interaction tools of three databases (Micromedex, Drugs.com, and Liverpool HIV Drug Interactions Checker) for potential DDIs detection. Methods: Drugs were selected from National List of Essential Medicines of Thailand (2021) and the Ramadhibodi Chakri Naruebodindra Hospital drug list. Potential DDIs were identified by the three databases. The agreement was determined by Fleiss’ kappa. Results: Seventeen antiretrovirals and 77 frequently prescribed medications from the National List of Essential Medicines of Thailand (2021) and the Ramadhibodi Chakri Naruebodindra Hospital drug list were included in this study. Overall, 383 pairs of potential DDIs were detected by the three databases. Drugs.com reported the highest number of DDIs (302 pairs), followed by the Liverpool (222 pairs) and Micromedex (160 pairs) databases. Among these DDIs, 113 pairs (29.5%) were reported as contraindicated or major severity in all three databases. The major DDI mechanisms were pharmacokinetic-based cytochrome P450 inhibition (33.4%) and induction (20.1%). Fleiss’ kappa agreements were slightly concordant among the three databases (0.0476). Conclusions: Healthcare provider vigilance is important to manage the potentially varying DDI information in different databases that could impact the safety and efficacy of HIV treatment.