Category: Federal Forum Posters
Purpose: Ritonavir and cobicistat are common components of antiretroviral therapy (ARV) used to boost the serum concentrations of protease inhibitors and elvitegravir through their inhibition of cytochrome P450 (CYP450) enzymes. Unfortunately, this CYP450 inhibition can result in critical interactions with hepatically metabolized medications. The objective of this study is to identify patients on a ritonavir or cobicistat-boosted ARV regimen concurrently with an interacting inhaled corticosteroid or statin and to optimize their regimens by modifying one of these components. The secondary objective is to assess the incidence of adverse effects associated with these interactions.
Methods: This study has been exempted by the Institutional Review Board. A chart review using the electronic medical record will be performed. Patients who have filled at least one prescription for an agent containing ritonavir or cobicistat and for an interacting inhaled corticosteroid or statin from September 1, 2016 through September 1, 2018 will be identified. Patients will be excluded if either agent has been discontinued by their provider, they have not filled either prescription within the past year, or they are no longer getting care at this institution. The following data will be collected: patient age; most recent SCr, AST, ALT, CPK, and LDL; HLA-B5701; nadir CD4; current HIV regimen; previous HIV regimens; toxicities/adverse events associated with previous regimens; interacting agent; indication for interacting agent; concurrent inhaled therapy if applicable; previous statin/corticosteroid regimens trialed; toxicities/adverse events associated with previous regimens; and current medications that have a moderate to severe level of interaction with ritonavir or cobicistat. Patients will be evaluated individually to determine which component of their regimens should be altered. The optimal plan will be recommended to the patient’s primary care provider. Once the provider approves, the alternative options will be discussed with the patient.
Results: Not applicable
Conclusion: Not applicable
Rachel Lumish– Student Pharmacist, University of Maryland School of Pharmacy, Baltimore, MD