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Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients: A Retrospective Analysis

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Abstract

Introduction

A higher rate of subtherapeutic psychotropic drug concentrations was recently found in HIV-infected versus HIV-negative patients. In this study, we sought to investigate if this trend could also apply to antiepileptic drugs.

Methods

Overall, 700 HIV-infected patients were screened during the first 2 years after the introduction of our outpatient polytherapy management service (Gestione Ambulatoriale Politerapie [GAP]) in the search for subjects with antiepileptic drug trough concentration assessments. The distribution of such concentrations was compared with that in HIV-negative patients monitored over the same period.

Results

The search identified 97 HIV-infected patients concomitantly receiving antiretroviral and antiepileptic drugs, for a total of 310 drug measurements. Overall, 30%, 64% and 6%, versus 28%, 65% and 7%, of the antiepileptic concentrations measured in HIV-infected versus HIV-negative patients (1090 patients, for a total of 3488 antiepileptic concentrations measured) were below, within, or above the therapeutic targets, respectively. The antiepileptic drug valproate was associated with the highest risk of subtherapeutic drug concentrations, with 57% and 46% of determinations below the therapeutic range in HIV-positive and HIV-negative patients, respectively. Remarkably, the concentrations of valproate were significantly lower in HIV-infected versus HIV-negative patients (47.9 ± 21.2 versus 53.9 ± 21.6 mg/L; p < 0.05).

Conclusion

In our retrospective study, most HIV-infected patients had antiepileptic drug concentrations falling within the therapeutic targets, with the exception of valproate, which was associated with a higher rate of subtherapeutic concentrations compared with other antiepileptic drugs.

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Funding

This study was carried out as part of our routine work, and no external funds were used.

Author information

Authors and Affiliations

  1. Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco, Milan, Italy

    Dario Cattaneo & Cristina Gervasoni

  2. Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, Milan, Italy

    Dario Cattaneo, Sara Baldelli, Marta Fusi & Valeria Cozzi

  3. Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy

    Andrea Giacomelli, Davide Minisci, Paola Meraviglia, Noemi Astuti, Massimo Galli & Cristina Gervasoni

  4. Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Sacco University Hospital, Università degli Studi di Milano, Milan, Italy

    Emilio Clementi

  5. E. Medea Scientific Institute, Bosisio Parini, Italy

    Emilio Clementi

  6. Department of Infectious Diseases, Luigi Sacco University Hospital, Via GB Grassi 74, 20157, Milan, Italy

    Cristina Gervasoni

Authors
  1. Dario Cattaneo
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  2. Sara Baldelli
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  3. Andrea Giacomelli
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  4. Davide Minisci
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  5. Paola Meraviglia
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  6. Noemi Astuti
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  7. Marta Fusi
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  8. Valeria Cozzi
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  9. Emilio Clementi
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  10. Massimo Galli
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  11. Cristina Gervasoni
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Corresponding author

Correspondence to Cristina Gervasoni.

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Conflicts of interest

Cristina Gervasoni and Massimo Galli have received educational grants from Merck Sharp & Dohme (MSD), Janssen-Cilag, Bristol Myers Squibb, Boehringer Ingelheim, ViiV Healthcare and Abbvie. Paola Meraviglia has received educational grants from Merck Sharp & Dohme (MSD), Janssen-Cilag, Bristol Myers Squibb, Boehringer Ingelheim and ViiV Healthcare. Dario Cattaneo has received educational and travel grants from Merck Sharp & Dohme (MSD) and ViiV Healthcare. Sara Baldelli, Andrea Giacomelli, Davide Minisci, Noemi Astuti, Marta Fusi, Valeria Cozzi, and Emilio Clementi declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Cattaneo, D., Baldelli, S., Giacomelli, A. et al. Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients: A Retrospective Analysis. Clin Pharmacokinet 58, 1345–1350 (2019). https://doi.org/10.1007/s40262-019-00752-6

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  • DOI: https://doi.org/10.1007/s40262-019-00752-6

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