Dario Cattaneo1,2, Sara Baldelli2, Chiara Resnati3, Andrea Giacomelli3, Paola Meraviglia3, Davide Minisci3, Noemi Astuti3, Annalisa Ridolfo3, Giuseppe V De Socio4, Emilio Clementi5,6, Massimo Galli3, Cristina Gervasoni1,3. 1. Gestione Ambulatoriale Politerapie (GAP) outpatient clinic, ASST Fatebenefratelli Sacco, Milan, Italy. 2. Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, Milan, Italy. 3. Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy. 4. Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy. 5. Clinical Pharmacology Unit, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Department of Biomedical and Clinical Sciences, Sacco University Hospital, Università degli Studi di Milano, Milan, Italy. 6. E. Medea Scientific Institute, Bosisio Parini, Italy.
Abstract
Objectives: The management of psychiatric illness in HIV-infected patients is clinically challenging because of the risk of potential drug-drug interactions. Here, we aimed to measure the antidepressant and/or antipsychotic drug concentrations in HIV-infected patients during routine outpatient visits. Methods: Six hundred HIV-infected patients were screened during the first 15 months after the introduction of our outpatient polytherapy management service in a search for subjects treated with psychotropic drugs for at least 3 months. The distribution of psychotropic drug concentrations in HIV-infected patients was compared with that observed in a control group of HIV-negative patients monitored over the same period. Results: The search identified 82 HIV-infected patients concomitantly receiving antiretroviral and psychotropic drug treatment, 55% of whom had plasma psychotropic drug concentrations that were below minimum effective levels. The same result was found in only 26% of the samples taken from HIV-negative patients. These results were not affected by patients' gender, age, adherence to therapies or drug-drug interactions.Conclusions: A higher rate of sub-therapeutic antidepressant and/or antipsychotic drugs concentrations were found in HIV-infected patients. The creation of multidiscliplinary specialist teams may contribute to improving the management of such complex patients.
Objectives: The management of psychiatric illness in HIV-infectedpatients is clinically challenging because of the risk of potential drug-drug interactions. Here, we aimed to measure the antidepressant and/or antipsychotic drug concentrations in HIV-infectedpatients during routine outpatient visits. Methods: Six hundred HIV-infectedpatients were screened during the first 15 months after the introduction of our outpatient polytherapy management service in a search for subjects treated with psychotropic drugs for at least 3 months. The distribution of psychotropic drug concentrations in HIV-infectedpatients was compared with that observed in a control group of HIV-negative patients monitored over the same period. Results: The search identified 82 HIV-infectedpatients concomitantly receiving antiretroviral and psychotropic drug treatment, 55% of whom had plasma psychotropic drug concentrations that were below minimum effective levels. The same result was found in only 26% of the samples taken from HIV-negative patients. These results were not affected by patients' gender, age, adherence to therapies or drug-drug interactions.Conclusions: A higher rate of sub-therapeutic antidepressant and/or antipsychotic drugs concentrations were found in HIV-infectedpatients. The creation of multidiscliplinary specialist teams may contribute to improving the management of such complex patients.
Entities:
Keywords:
Drug interactions; antidepressants; antipsychotics; pharmacotherapy; psychopharmacology