PURPOSE: To evaluate the impact of enzyme-inducing antiepileptic drugs (EI-AEDs) on serum antiretroviral (ARV) levels in patients with HIV. METHODS:Data from the U.S. Military HIV Natural History Study were screened to identify participants taking ARVs with EI-AEDs and controls taking ARVs with non enzyme-inducing AEDs (NEI-AEDs). The proportion of serum ARV levels below the recommended minimum concentrations (C(min)) was compared between these groups. RESULTS:ARV levels were available for 10 individuals exposed to 16 intervals on combined ARVs/EI-AEDs (phenytoin and carbamazepine) and for 25 controls exposed to 30 overlap intervals on combined ARVs/NEI-AEDs. The percentage of overlap intervals with ≥1 ARV levels below C(min) was higher in the EI-AED group than in controls (37.5% vs. 23.3%; p=0.124). After excluding intervals associated with serum levels of EI-AEDs below the reference range (n=6), the proportion of intervals with ≥1 ARV level below C(min) was significantly greater among EI-AED recipients (60%) compared to controls (23.3%; p=0.008). CONCLUSIONS:ARV levels below C(min) were more common in participants receiving EI-AEDs, the difference being statistically significant for intervals associated with EI-AED levels within the reference range. These data suggest that, in agreement with current guidelines, EI-AEDs should be avoided in patients receiving ARV therapy.
RCT Entities:
PURPOSE: To evaluate the impact of enzyme-inducing antiepileptic drugs (EI-AEDs) on serum antiretroviral (ARV) levels in patients with HIV. METHODS: Data from the U.S. Military HIV Natural History Study were screened to identify participants taking ARVs with EI-AEDs and controls taking ARVs with non enzyme-inducing AEDs (NEI-AEDs). The proportion of serum ARV levels below the recommended minimum concentrations (C(min)) was compared between these groups. RESULTS: ARV levels were available for 10 individuals exposed to 16 intervals on combined ARVs/EI-AEDs (phenytoin and carbamazepine) and for 25 controls exposed to 30 overlap intervals on combined ARVs/NEI-AEDs. The percentage of overlap intervals with ≥1 ARV levels below C(min) was higher in the EI-AED group than in controls (37.5% vs. 23.3%; p=0.124). After excluding intervals associated with serum levels of EI-AEDs below the reference range (n=6), the proportion of intervals with ≥1 ARV level below C(min) was significantly greater among EI-AED recipients (60%) compared to controls (23.3%; p=0.008). CONCLUSIONS: ARV levels below C(min) were more common in participants receiving EI-AEDs, the difference being statistically significant for intervals associated with EI-AED levels within the reference range. These data suggest that, in agreement with current guidelines, EI-AEDs should be avoided in patients receiving ARV therapy.
Authors: Ronald J Ellis; Debralee Rosario; David B Clifford; Justin C McArthur; David Simpson; Terry Alexander; Benjamin B Gelman; Florin Vaida; Ann Collier; Christina M Marra; Beau Ances; J Hampton Atkinson; Robert H Dworkin; Susan Morgello; Igor Grant Journal: Arch Neurol Date: 2010-05
Authors: Rafaëlla F A L'homme; Tim Dijkema; Andre J A M van der Ven; David M Burger Journal: J Acquir Immune Defic Syndr Date: 2006-10-01 Impact factor: 3.731
Authors: Eva P Muro; Quirine Fillekes; Elton R Kisanga; Rafaëlla L'homme; Susan C Aitken; Godfrey Mariki; Andre J A M Van der Ven; Wil Dolmans; Rob Schuurman; A Sarah Walker; Diana M Gibb; David M Burger Journal: J Acquir Immune Defic Syndr Date: 2012-03-01 Impact factor: 3.731
Authors: Gretchen L Birbeck; Jacqueline A French; Emilio Perucca; David M Simpson; Henry Fraimow; Jomy M George; Jason F Okulicz; David B Clifford; Houda Hachad; René H Levy Journal: Epilepsia Date: 2012-01 Impact factor: 5.864
Authors: Vincent C Marconi; Greg A Grandits; Amy C Weintrob; Helen Chun; Michael L Landrum; Anuradha Ganesan; Jason F Okulicz; Nancy Crum-Cianflone; Robert J O'Connell; Alan Lifson; Glenn W Wortmann; Brian K Agan Journal: AIDS Res Ther Date: 2010-05-27 Impact factor: 2.250
Authors: Jason F Okulicz; Greg A Grandits; Jacqueline A French; Jomy M George; David M Simpson; Gretchen L Birbeck; Anuradha Ganesan; Amy C Weintrob; Nancy Crum-Cianflone; Tahaniyat Lalani; Michael L Landrum Journal: AIDS Res Ther Date: 2011-05-16 Impact factor: 2.250
Authors: Melissa A Elafros; Gretchen L Birbeck; Joseph C Gardiner; Omar K Siddiqi; Izukanji Sikazwe; Nigel Paneth; Christopher M Bositis; Jason F Okulicz Journal: Am J Trop Med Hyg Date: 2017-06 Impact factor: 2.345
Authors: Kiran T Thakur; Alexandra Boubour; Deanna Saylor; Mitashee Das; David R Bearden; Gretchen L Birbeck Journal: AIDS Date: 2019-02-01 Impact factor: 4.177