HIV disease–related drug reaction
Special populations of people, such as those who are HIV-positive, can be up to a hundred times more susceptible to immune-mediated adverse drug reactions than the general public.
[2][3] Commonly prescribed medications for HIV, such as sulfonamides, anticonvulsants, antibacterials, antifungals, antimycobacterials, and, most notably, antiretrovirals, have an increased incidence of adverse cutaneous drug reactions in HIV-positive individuals, and even greater escalation of incidence in people with advanced disease progression in the form of AIDS.
Non-nucleoside reverse transcriptase inhibitors have been shown to have the highest rate of causing immune-related drug reactions in people who are HIV positive.
Trimethoprim-sulfamethoxazole, also known by the brands Bactrim or Septra have caused adverse cutaneous drug reactions at an incidence of 2.6%-8% in the general population, but 43%-69% in patients with HIV infection or AIDS.
[7] A retrospective study of adult patients with Pneumocystis jirovecii pneumonia and AIDS who were admitted to Veterans General Hospital in Taiwan between January 2006 to December 2011 and treated with trimethoprim-sulfamethoxazole demonstrated a high incidence of adverse drug reactions that mostly involved the skin and liver.
[9] Despite the success in efforts to treat and control the disease with these medications, there are reports of people who received treatment and developed a severe adverse drug reaction such as a drug-induced liver injury (DILI).
Genetic variations in drug metabolizing enzymes are associated with a higher risk of adverse drug reactions in people with HIV taking antiretrovirals, and it may become recommended under the practice of precision medicine to screen for genetic susceptibility to adverse effects based on these enzymes.
[10] Drug-induced liver injury is a common cause of prolonged hospital stays for people with HIV, and in more severe reactions can be life-threatening.
Studies have reported that efavirenz is a potential agent that caused drug induced liver injury in HIV-positive patients taking the first line antiretroviral therapy of efavirenz/tenofovir disoproxil fumarate/emtricitabine fixed‐dose combination.
[11][12] Other reported risk factors for drug induced liver injury are female gender, young age, and high CD4+ count of >200 cells/mm3.
Because of its DNA chain terminator feature, the bone marrow may be suppressed so that its production of red blood cells is decreased.
Type A lactic acidosis is mainly caused by the systemic ischemia since the oxygen has trouble being delivered to tissues and that the biochemical metabolic pathway is shifted to glycolysis to generate ATP.
After eight days of treatment, they were forced to halt all medication therapy as they had developed a severe pruritic cutaneous adverse reaction to darunavir/r.
[25] Unlike precision medicine, there a greater number of medications that have existing desensitization protocols proven to help decrease the incidence of adverse drug reactions in people with HIV.
[28] It is important to consider these physiologic changes when prescribing or administering medications to treat HIV in HIV-positive individuals above 65 years of age.
Older age, smoking, and longer duration of HIV infection are associated with increased risk of developing multiple conditions in addition to HIV, such as hypertension, dyslipidemia, diabetes mellitus, kidney disease, cardiovascular disease, respiratory disorders, bone disorders or cancer.
