Pre- and Post-Exposure Prophylaxis for HIV in Patients Taking Anti-Seizure Medications

Area of Science:

• Pharmacology
• Infectious Diseases
• Neurology

Background:

• HIV prevention increasingly relies on pre- and post-exposure prophylaxis (PrEP/PEP).
• Co-prescribing anti-seizure medications (ASM) with antiretroviral treatments (ARTs) presents challenges due to numerous new drug options since 2012.
• Historical challenges include virologic failure, healthcare access barriers, and stigma associated with both HIV and seizures.

Purpose of the Study:

• To review pharmacokinetic (PK) interactions between guideline-based PrEP/PEP and ASMs.
• To identify overlapping side effects of these drug classes.
• To provide a clinical resource for managing co-treatment and reducing HIV risk.

Main Methods:

• Narrative review of existing data on drug interactions.
• Focus on pharmacokinetic interactions between PrEP/PEP and specific ASMs (enzyme-inducing, valproate, lamotrigine).
• Analysis of overlapping adverse events.

Main Results:

• Enzyme-inducing ASMs can reduce serum levels of tenofovir-containing PrEP and PEP components (dolutegravir, raltegravir, ritonavir), potentially impacting HIV treatment efficacy.
• Ritonavir in PEP may significantly lower lamotrigine levels, increasing seizure breakthrough risk and post-treatment skin reactions.
• Common overlapping side effects include osteopenia, hepatic toxicity, and gastrointestinal issues.

Conclusions:

• Clinicians need to be aware of PK interactions and overlapping side effects when co-prescribing ASMs and PrEP/PEP.
• Management strategies are crucial to ensure successful seizure treatment and effective HIV prevention.
• Further research is needed to address knowledge gaps and unmet needs in this area.