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Master Thesis

Sujets âgés infectés par le VIH et interactions médicamenteuses : cohorte rétrospective française à partir des données nationales du SNIIRAM

Abstract : Older people living with HIV (PLWH) are at higher risk for major drug-drug interactions (MDDI) due to polypharmacy. This thesis aimed to describe the frequency, risk factors and costs attributable to MDDI among an ageing French HIV population. A retrospective cohort study was conducted, using French nationwide healthcare e-records: the SNIIRAM database. PLWH aged more than 65 years old and receiving combined antiretroviral treatment (cART) in 2016 were included. The outcome was a MDDI reported as a "Do Not Co-administer" statement, according to the University of Liverpool website. Attributable MDDI costs were defined as the difference between individuals with or without MDDI regarding all reimbursed healthcare acts. The baseline characteristics of the 9,076 PLWH were: mean age, 71.3±4.9 years; 25% female; median HIV duration, 16.2 years [IQR, 9.5-20.3]; median comorbidities, 2 [IQR, 1-3]. During 2016, they received a median of 14 [IQR, 9-21] co-medications (noncART) and 16.8% of PLWH had at least one MDDI (95%CI [16.1-17.6]). In multivariate analysis, raltegravir or dolutegravir plus 2 NRTI significantly and independently reduced the risk of MDDI (aOR, 0.02, 95%CI [0.005-0.050], p<0.01) compared with NNRTI plus 2 NRTIs while boosted-third agent significantly increased the risk (aOR, 4.12, 95%CI [3.34-5.10], p<0.01). Compared with propensity-score matched PLWH without MDDI, the presence of MDDI was associated with a $2,693 additional annual cost (p<0.01). In this French population-based study, 1 out of 6 patients had a "Do Not Coadminister" warning. Raltegravir or dolutegravir plus 2 NRTI should be preferred to limit risks and costs of MDDI in this ageing population.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02458014
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Submitted on : Tuesday, January 28, 2020 - 2:15:49 PM
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  • HAL Id : dumas-02458014, version 1

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Ludivine Demessine. Sujets âgés infectés par le VIH et interactions médicamenteuses : cohorte rétrospective française à partir des données nationales du SNIIRAM. Sciences pharmaceutiques. 2018. ⟨dumas-02458014⟩

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