Concurrent use of antiretrovirals and anticonvulsants in human immunodeficiency virus (HIV) seropositive patients.

Seizure disorders may complicate HIV disease, either as a direct result of HIV or as a manifestation of a secondary opportunistic infection. Unless a reversible cause of seizure activity can be discerned, current treatment guidelines recommend the use of anticonvulsant drugs in these patients. The concurrent use of antiretrovirals and anticonvulsants is a poorly studied area. Controlled clinical trials examining drug-drug and drug-disease interactions in this area are scant, leaving clinicians a therapeutic dilemma in terms of drug selection. Most studies have been retrospective in nature. Generalized seizures appear to be most common and occur most frequently in patients with more severe disease as indicated by lower mean CD4(+) cell counts. In short follow-up periods, seizures appear to recur relatively frequently. Treatment of seizures in this population is hindered by a lack of clear data and numerous reports of drug-drug and drug-disease interactions. In order to best provide evidence-based care, controlled clinical trials are needed to discern which anticonvulsants are best suited for use in this population. Trials should also examine appropriate dose adjustments that may be warranted when anticonvulsants and antiretrovirals agents are used concurrently. Unless an identifiable and reversible cause of seizures is identified in this patient population seizures should be treated with standard therapy and close follow-up and monitoring. Newer anticonvulsants (i.e., gabapentin, tiagabine) with fewer drug interactions may be better alternatives when compared to older anticonvulsant agents. Clinicians might avoid valproic acid given some conflicting reports regarding potential for increasing viral replication.