4.6 Article

Higher plasma drug levels in elderly people living with HIV treated with darunavir

Journal

PLOS ONE
Volume 16, Issue 2, Pages -

Publisher

PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0246171

Keywords

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Funding

  1. Bristol-Myers Squibb [BMS AI424-975]
  2. Swedish State Support for Clinical Research [ALFGBG-717531]

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In this study, it was found that elderly PLHIV aged >= 65 years had higher steady-state plasma levels of DRV and ATV compared to controls <= 49 years of age, while no significant differences were observed in the EFV arm. The DRV arm had a higher frequency of reported side effects compared to the ATV and EFV arms in the study group.
Background The proportion of elderly people living with HIV-1 (PLHIV) is rising. In older patients, comorbidities and concomitant medications are more frequent, increasing the risk of potential drug-drug interactions (PDDIs). Data on the pharmacokinetics of ART in individuals aged >= 65 years of age are scarce. We compared plasma drug levels of ART, PDDIs, and side-effects in PLHIV aged >= 65 years of age, with controls <= 49 years of age. Methods Patients >= 65 years of age and controls <= 49 years of age, all of whom were on stable treatment with atazanavir (ATV), darunavir (DRV), or efavirenz (EFV) were included cross-sectionally. Plasma drug levels of ART were analyzed, comorbidities, concomitant medication, adherence, and side-effects recorded, and PDDIs analyzed using drug interactions databases. Results Between 2013 and 2015, we included 100 individuals >= 65 years of age (study group) and 99 controls (<= 49 years of age). Steady-state DRV concentrations were significantly higher in the study group than in the control group (p = 0.047). In the ATV group there was a trend towards a significant difference (p = 0.056). No significant differences were found in the EFV arm. The DRV arm had a higher frequency of reported side-effects than the ATV and EFV arms in the study group (36.7% vs. 0% and 23.8% respectively (p = 0.014), with significant differences between DRV vs. ATV, and EFV vs. ATV). Conclusions Higher steady-state plasma levels of DRV and ATV (but not EFV) were found in PLHIV aged >= 65 years of age, compared to controls <= 49 years of age.

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