Characteristics and evaluation of potential drug interactions among HIV/AIDS outpatients: a retrospective study at primary health center in a North Lampung regency, Indonesia
Abstract
People living with HIV/AIDS require lifelong antiretroviral therapy (ART) and frequently experience complications and comorbidities that raise the risk of drug-drug interactions. This study aimed to characterize the patients, describe their medication use, and identify potential drug interactions among HIV/AIDS patients at a primary health center in North Lampung Regency. We performed a retrospective, descriptive review of medical records from January to December 2024. All eligible HIV/AIDS patients (N = 31) were included via total sampling. Drug interaction screening used the Lexicomp® application and Stockley’s Drug Interactions. The results showed that most HIV/AIDS patients were male (74.19%), aged 36–45 years (41.93%), and classified as WHO clinical stage I (38.70%). The first‑line ART regimen TLE (tenofovir + lamivudine + efavirenz) was prescribed to 54.8% of patients. A total of 35 potential interactions were identified: 65.7% were moderate pharmacokinetic, 28.6% minor pharmacokinetic, and 5.7% pharmacodynamic (2.9% major and 2.9% moderate). Moderate pharmacokinetic interactions predominated, underscoring the importance of proactive screening and ongoing medication review by pharmacists to prevent adverse events and optimize therapy in HIV/AIDS care.
References
Fauci AS, Lane HC. Human immunodeficiency virus disease: AIDS and related disorders. In: Kasper DL, Fauci AS, Hauser SL, et al., editors. Harrison’s Principles of Internal Medicine. 20th ed. New York (NY): McGraw‑Hill; 2018. p. 1397–1470.
Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–1533. https://doi.org/10.1016/S0140-6736(13)61809-7
UNAIDS. Global HIV & AIDS statistics – Fact sheet. 2024. Geneva: Joint United Nations Programme on HIV/AIDS. Available from: https://www.unaids.org/en/resources/fact-sheet
World Health Organization. HIV data and statistics. 2024. Geneva: WHO. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
Jocelyn, Nasution FM, Nasution NA, Asshiddiqi MH, Kimura NH, Siburian MHT, et al. HIV/AIDS in Indonesia: current treatment landscape, future therapeutic horizons, and herbal approaches. Front Public Health. 2024;12:1298297. https://doi.org/10.3389/fpubh.2024.1298297
UNAIDS. HIV and AIDS Estimates. Available from: https://unaids.org/en/regionscountries/countries/indonesia
Wardhani BDK, Grulich AE, Kawi NH, Prasetia Y, Luis H, Wirawan GBS, et al. Very high HIV prevalence and incidence among men who have sex with men and transgender women in Indonesia: a retrospective observational cohort study in Bali and Jakarta, 2017–2020. J Int AIDS Soc. 2024;27(3):e26386. https://doi.org/10.1002/jia2.26386
SIHA. Laporan Eksekutif Perkembangan HIV AIDS dan Penyakit Infeksi Menular Seksual (PIMS) Triwulan I Tahun 2023. Jakarta: Sistem Informasi HIV AIDS; 2023.
Morales DR, Moreno‑Martos D, Matin N, McGettigan P. Health conditions in adults with HIV compared with the general population: A population‑based cross‑sectional analysis. EClinicalMedicine. 2022;47:101392. https://doi.org/10.1016/j.eclinm.2022.101392
Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in HIV‑infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. 2024. Available from: https://clinicalinfo.hiv.gov/guidelines
Siripurapu R, Ota Y. Human Immunodeficiency Virus: Opportunistic Infections and Beyond. Neuroimaging Clin N Am. 2023;33(1):147–165. https://doi.org/10.1016/j.nic.2022.07.014
De Francesco D, Verboeket SO, Underwood J, Bagkeris E, Wit FW, Mallon PWG, et al. Pharmacokinetic and Clinical Observations in PeoPle Over fiftY (POPPY) study and the AGEhIV Cohort Study. Patterns of Co‑occurring Comorbidities in People Living With HIV. Open Forum Infect Dis. 2018;5(11):ofy272. https://doi.org/10.1093/ofid/ofy272
Currier JS, Havlir DV. CROI 2024: Metabolic and Other Complications of HIV Infection. Top Antivir Med. 2024;32(2):467–474. https://doi.org/10.1093/cid/ciae234
World Health Organization. Tuberculosis & HIV. 2024. Geneva: WHO. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/tuberculosis-hiv
Navasardyan I, Miwalian R, Petrosyan A, Yeganyan S, Venketaraman V. HIV-TB Coinfection: Current Therapeutic Approaches and Drug Interactions. Viruses. 2024 Feb 21;16(3):321. https://doi.org/10.3390/v16030321
Alum EU, Uti DE, Ugwu OP, Alum BN. Toward a cure – Advancing HIV/AIDs treatment modalities beyond antiretroviral therapy: A Review. Medicine (Baltimore). 2024;103(27):e38768. https://doi.org/10.1097/MD.0000000000038768
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services; 2024. Available from: https://clinicalinfo.hiv.gov/guidelines
World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: WHO; 2021.
De Bellis E, Donnarumma D, Zarrella A, Mazzeo SM, Pagano A, Manzo V, et al. Drug‑Drug Interactions Between HIV Antivirals and Concomitant Drugs in HIV Patients: What We Know and What We Need to Know. Pharmaceutics. 2024;17(1):31. https://doi.org/10.3390/pharmaceutics17010031
Lu CH, Bednarczyk EM, Catanzaro LM, Shon A, Xu JC, Ma Q. Pharmacokinetic drug interactions of integrase strand transfer inhibitors. Curr Res Pharmacol Drug Discov. 2021;2:100044. https://doi.org/10.1016/j.crphar.2021.100044
Al Sayed HAH, Sharif-Askari NS, Rahimi MR. Clinically significant drug interactions between antiretroviral and co-prescribed drugs in HIV infected patients: retrospective cohort study. Med Pharm Rep. 2022 Jul;95(3):260-266. https://doi.org/10.15386/mpr-2305
Resende NH, Miranda SS, Ceccato MDGB, Reis AMM, Haddad JPA, Silva DID, Carvalho WDS. Assessment of factors associated with potential drug‑drug interactions in patients with tuberculosis and HIV/AIDS. Rev Soc Bras Med Trop. 2021;54:e01032021. https://doi.org/10.1590/0037-8682-0103-2021
Gong Y, Haque S, Chowdhury P, Cory TJ, Kodidela S, Yallapu MM, et al. Pharmacokinetics and pharmacodynamics of cytochrome P450 inhibitors for HIV treatment. Expert Opin Drug Metab Toxicol. 2019 May;15(5):417-427. https://doi.org/10.1080/17425255.2019.1604686
National Institutes of Health. Overview: Drug‑Drug Interactions between Antiretrovirals and Other Drugs. 2024. Available from: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-overview
Miller CD, El‑Kholi R, Faragon JJ, Lodise TP. Prevalence and risk factors for clinically significant drug interactions with antiretroviral therapy. Pharmacotherapy. 2007;27(10):1379–1386. https://doi.org/10.1592/phco.27.10.1379
Awadh A, Badri Z, Alansari N, Alkhiri A, Baharoon H, Niaz A, et al. Effects of comorbid conditions and prescribed chronic medications on the treatment plan for chronic hepatitis C infection: A cross-sectional retrospective study. Health Sci Rep. 2024;7(5):e2055. https://doi.org/10.1002/hsr2.2055
Molino CGRC, Carnevale RC, Rodrigues AT, Moriel P, Mazzola PG. HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems. Saudi Pharm J. 2017 Jul;25(5):724-733. https://doi.org/10.1016/j.jsps.2016.11.004
HIV Medicine Association of the Infectious Diseases Society of America; Horberg HIV MA. Primary Care Guidance for Providers Who Care for Persons With Human Immunodeficiency Virus: 2024 Update by HIVMA/IDSA. Clin Infect Dis. 2024;79(2):e82–e141. https://doi.org/10.1093/cid/ciae256
Patel A, Pundkar A, Agarwal A, Gadkari C, Nagpal AK, Kuttan N. A Comprehensive Review of HIV-Associated Tuberculosis: Clinical Challenges and Advances in Management. Cureus. 2024;16(9):e68784. https://doi.org/10.7759/cureus.68784
Navaneethapandian P, Treatment of Tuberculosis and the Drug Interactions Associated With HIV-TB Co‑Infection Treatment. Front Trop Dis. 2022;3:834013. https://doi.org/10.3389/fitd.2022.834013
Kemenkes RI. Profil Kesehatan Indonesia 2023. Jakarta: Kementerian Kesehatan RI; 2024. Available from: https://kemkes.go.id/app_asset/file_content_download/172231123666a86244b83fd8.51637104.pdf. Accessed: Apr. 16, 2025. [Online].
Anggriani A, Lisni I, Wiku OS. Pola Penggunaan Obat Antiretroviral (ARV) Pada Resep Pasien Rawat Jalan Dari Klinik HIV/AIDS Salah Satu Rumah Sakit Swasta Di Kota Bandung. JRKI. 2019;1(1):10. https://doi.org/10.33759/jrki.v1i1.10
Salasanti CD, Zakiyah WU, Cahyati KI. Interaksi Obat Antiretroviral Pada Pasien HIV/AIDS di RSUD dr. Soekardjo Tasikmalaya Periode Januari–Maret 2022. Prosiding Seminar Nasional Diseminasi Hasil Penelitian Program Studi S1 Farmasi. 2022.
Viyani RSA, Kurniasari K. Hubungan Status Imunologis dengan Stadium Klinis pada Pasien Human Immunodeficiency Virus (HIV). Medical Scope Journal. 2024;7(1):133–140. https://doi.org/10.35790/msj.v7i1.55502
Ermawan B. Asuhan Keperawatan Pada Pasien Dengan Gangguan Sistem Imunologi. Yogyakarta: Pustaka Baru Press; 2017.
Triyono EA, Tan F, Wahyunitasari MR, The Prevalence of Candidiasis Oris, Tuberculosis, and Anemia in Hospitalized HIV Patients Admitted in Dr. Soetomo General Hospital, Surabaya, Indonesia, Mal J Med Health Sci. 2021;17(2): 46-53.
Gultom R. Evaluasi Pola Terapi Pengobatan Penyakit‑Penyerta (Komorbid) Pada Pasien HIV/AIDS Di Ruang Rawat Inap Rumah Sakit Umum Imelda Pekerja Indonesia Medan. J Ilmiah Farmasi Imelda. 2022;6(1):1–10. https://doi.org/10.52943/jifarmasi.v6i1.1112
Vitriaadhitama L, Lukitasari D, Martasari M. Profil Dan Kesesuaian Terapi Antiretroviral (ARV) Pada Pasien Human Immunodeficiency Virus / Acquired Immuno Deficiency Syndrome (HIV/AIDS). Java Health Journal. 2022;9(3).
Jaringan Indonesia Positif. Buku Saku Pengobatan ARV Bagi Petugas Lapangan Komunitas Edisi 1. Jakarta: Jaringan Indonesia Positif; 2020.
P2PL Kemenkes. Temukan TB Obati Sampai Sembuh Penatalaksanaan Tuberkulosis Resisten Obat di Indonesia. 2020.
Lerebulan EF, Etnis BR, Palulun ER. Gambaran Interaksi Obat pada Pasien Human Immunodeficiency Virus Koinfeksi Tuberkulosis Di BLUD RSUD Sele Be Solu Kota Sorong. 2020. Available from: http://ojs.stikessorong.ac.id.
Yuniarti N, Yuswar MA, Untari EK. Kejadian Interaksi Obat pada Pasien HIV/AIDS Yang Menerima Antiretroviral di RSUD dr. Soedarso Pontianak periode 2018. JC. 2020;6(1):43345. https://doi.org/10.26418/jc.v6i1.43345
Lexicomp. UpToDate Drug Interaction Checker: Lexicomp. Wolters Kluwer; 2025. Available from: https://www.wolterskluwer.com/en/solutions/uptodate/drug-decision-support.
British National Formulary. 76th ed. London: BMJ Publishing Group; 2018. Available from: www.sps.nhs.uk/ukdilas.
Moore KH, Yuen GJ, Raasch RH, Eron JJ, Martin D, Mydlow PK, et al. Pharmacokinetics of Lamivudine Administered Alone and With Trimethoprim‑Sulfamethoxazole. Clin Pharmacol Ther. 1996;59(5):550–558. https://doi.org/10.1016/S0009-9236(96)90183-6
Sabo JP, Lamson MJ, Leitz G, Yong CL, MacGregor TR. Pharmacokinetics of Nevirapine and Lamivudine in Patients With HIV‑1 Infection. AAPS PharmSci. 2000;2(1):E1. https://doi.org/10.1208/ps020101
Stockley LH. Stockley’s Drug Interactions. 9th ed. London: Pharmaceutical Press; 2010.
Bickel M, Khaykin P, Stephan C, Schmidt K, Buettner M, Amann K, Lutz T, et al. Acute Kidney Injury Caused by Tenofovir Disoproxil Fumarate and Diclofenac Co‑Administration. HIV Med. 2013;14(10):633–638. https://doi.org/10.1111/hiv.12072
Dal Pan GJ. The Use of Real‑World Data to Assess the Impact of Safety‑Related Regulatory Interventions. Clin Pharmacol Ther. 2022;111(1):98–107. https://doi.org/10.1002/cpt.2464
Upreti VV, Kwatra D, Minocha M, et al. Effect of Extremes of Body Weight on the Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of Apixaban in Healthy Subjects. Br J Clin Pharmacol. 2013;76(6):908–916. https://doi.org/10.1111/bcp.12114
Herdaningsih S, Muhtadi A, Lestari K, Annisa N. Potential of Drug‑Drug Interaction in Polypharmacy Prescription: Retrospective Study on a Drugstore in Bandung. Indonesian Journal of Clinical Pharmacy. 2016;5(4):288–292. https://doi.org/10.15416/ijcp.2016.5.4.288
Copyright (c) 2025 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
