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Balancing the Interactions: Assessing Antiplatelet and Antiretroviral Therapy Drug-Drug Interactions in People Living

Athena Matsikas1, Kassandra Marsh1, Quy Huynh1

  • 1Department of Pharmacy, NYU Langone Health, New York, NY; and.

Journal of Cardiovascular Pharmacology
|November 12, 2024
PubMed

Insights

Drug-drug interactions (DDIs) between antiplatelet drugs and antiretroviral therapy (ART) are common in people living with HIV. However, these DDIs did not correlate with major adverse cardiovascular events or bleeding within one year.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Drug-drug interactions (DDIs) between antiplatelet agents and antiretroviral therapy (ART) are a concern for cardiovascular health in people living with HIV (PLWH).
  • The clinical impact of these specific DDIs on bleeding and thrombotic events remains largely uncharacterized.

Purpose of the Study:

  • To determine the incidence of DDIs at the initiation of P2Y12 inhibitors (P2Y12inh) in PLWH on ART.
  • To evaluate the association between DDIs and patient outcomes, including bleeding events and major adverse cardiovascular events (MACE).

Main Methods:

  • Retrospective study design including adult PLWH initiating oral P2Y12inh therapy.
  • Assessment of DDIs between ART and P2Y12inh at the time of P2Y12inh initiation.
  • Tracking of secondary outcomes: bleeding events, MACE, and P2Y12inh switches within one year.

Main Results:

  • A high incidence of DDI was observed (60%), particularly with clopidogrel (71%) and ticagrelor (39%).
  • Within one year, MACE occurred in 12 PLWH and bleeding events in 29; 4 MACE and 17 bleeding events had concurrent DDIs.
  • Notably, 88% of DDIs in patients with bleeding events were predicted to decrease P2Y12inh efficacy, yet MACE and bleeding did not correlate with DDI presence at initiation.

Conclusions:

  • While DDIs between P2Y12inh and ART are frequent in PLWH, they did not show a correlation with MACE or bleeding events at one year in this cohort.
  • Further research is needed to ascertain if DDIs at initiation cause adverse outcomes or if underlying factors in PLWH influence these events.

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