(266) Identifying Potential Drug Interactions in Kidney-Impaired Individuals Co-infected with Human Immunodeficiency Virus and Malaria in Lagos: A Focus for Enhancing Treatment Strategies.

Background: An increasing concern revolves around drug interactions, particularly in individuals co-infected with HIV and malaria, and concurrently experience renal impairment.

Objectives: This study aims to evaluate treatment patterns for malaria and investigate clinically significant drug interactions among HIV-infected patients with renal disease at Lagos University Teaching Hospital.

Methods: We retrospectively analyzed 6,875 HIV cases from June 2015 to May 2021 using a detailed questionnaire for demographic and clinical data. Potentially harmful drug interactions were assessed with Micromedex® software. The primary outcome measure was to evaluate clinically significant drug interactions in individuals with HIV, malaria, and kidney impairment. Data analysis was performed using SPSS version 20.0, with a significance level set at p< 0.05.

Results: Within the evaluated cohort, 7% (n= 480) of patients were noted to have documented episodes of malaria and signs of renal impairment. Malaria diagnosis was achieved through clinical assessment and parasite detection in 17% of cases. Artemisinin-based Combination Therapy (ACT) was the predominant prescription for malaria treatment, accounting for 93.8% (n=450) of cases, followed by sulphadoxine-pyrimethamine 4.3% (n=21). Among the ACT prescriptions, artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) were prescribed in 92.9% (n = 418) and 2.4% (n=11) of cases, respectively. Dolutegravir-based Antiretroviral Therapy (ART) was prescribed in 68.8% (n=323), primarily as Tenofovir/Lamivudine/Dolutegravir (TLD) combinations. Utilizing drug interaction software, we found that the prevalence of clinically significant drug interactions (CSDI) was 28.8% (1,144) among a total of 3,928 prescriptions involving antimalarial and co-prescribed medications. Pharmacokinetic drug interaction types were documented in 70% (n=841) of prescriptions. Notably, the software identified no significant interaction between DTG-based ART and ACT.

Conclusions: Artemisinin-based Combination Therapies were the predominant antimalarial choice in the study. Remarkably, a quarter of prescriptions, encompassing both antimalarial and concurrent medications, resulted in clinically significant drug interactions.