Drug-drug interactions with antiretroviral therapy among people living with HIV in Asia and other regions: risk factors and impact on indicators of health-related quality of life

Introduction While studies have extensively examined the clinical and pharmacokinetic correlates of drug-drug interactions (DDIs) with antiretroviral therapy (ART), less is known about DDIs from the perspective of people living with HIV (PLHIV). Among an international sample of PLHIV, we examined experiences, concerns and challenges regarding DDIs. Methods Data came from an international, web-based survey that was conducted among adult PLHIV aged ≥18 years who were receiving ART during 2019 (Positive Perspectives Wave 2, n=2389). Data were analyzed using descriptive statistics and with a special focus on the Asian region comprising participants from China, Taiwan, Japan, and South Korea (n=230). Multivariable analyses were performed using pooled data from all 2389 participants. Statistical significance was at p<0.05. Results Overall, 59.1% (136/230) of Asian participants were concerned about the risk of DDIs, 58.3% (134/230) were concerned about having to take more medicines as they grew older, and 25.9% (44/170) of those who had ever switched ART attributed it to DDIs, higher than every other geographical region except North America. Among Asian participants, 86.0% (43/50) of those aged ≥50 years reported having ever been diagnosed with a non-HIV comorbidity versus 60.0% (108/180) aged <50 years (p=0.001). Within the pooled sample, adults aged ≥50 years were more likely to perceive the need to reduce DDIs as a current treatment priority, than younger adults (adjusted prevalence ratio, APR=1.14; 95% CI: 1.02–1.27). The percentage of the entire population that ever switched ART because of DDIs ranged from 10.6% (148/1402) among those receiving treatment for HIV only, to 26.4% (14/53) among those receiving treatment for ≥7 conditions (including HIV). Conclusions Older adults reported more comorbidities than younger ones, and the probability of having switched ART because of DDIs increased with increasing concurrent treatments. Providing simpler regimens may help reduce the risk of DDIs. Healthcare providers can improve PLHIV’s health-related quality of life by delivering person-centered care.