Login Register Cart 0
Generic placeholder image

Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Co-medications and Drug-Drug Interactions in People Living with HIV in Turkey in the Era of Integrase Inhibitors

Author(s): Zuhal Yeşilbağ*, Emine İlay Şengül, Sevtap Şenoğlu, Özlem Altuntaş Aydın and Hayat Kumbasar Karaosmanoğlu

Volume 18, Issue 6, 2020

Page: [415 - 425] Pages: 11

DOI: 10.2174/1574885515666200812215140

Price: $65

Abstract

Background: Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors.

Methods: A retrospective observational study was conducted between January 2016-August 2019. Patients’ characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs.

Results: Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs.

Conclusion: Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.

Keywords: Co-medication, drug-drug interactions, elvitegravir/cobicistat, HIV, inhaled drugs, integrase inhibitors.

« Previous Next »
Graphical Abstract

[1]
Palella FJ Jr, Delaney KM, Moorman AC, et al. HIV Outpatient Study Investigators. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998; 338(13): 853-60.
[http://dx.doi.org/10.1056/NEJM199803263381301] [PMID: 9516219]
[2]
Marzolini C, Back D, Weber R, et al. Swiss HIV Cohort Study Members. Ageing with HIV: medication use and risk for potential drug-drug interactions. J Antimicrob Chemother 2011; 66(9): 2107-11.
[http://dx.doi.org/10.1093/jac/dkr248] [PMID: 21680580]
[3]
Krentz HB, Cosman I, Lee K, Ming JM, Gill MJ. Pill burden in HIV infection: 20 years of experience. Antivir Ther (Lond) 2012; 17(5): 833-40.
[http://dx.doi.org/10.3851/IMP2076] [PMID: 22358155]
[4]
Volberding PA, Deeks SG. Antiretroviral therapy and management of HIV infection. Lancet 2010; 376(9734): 49-62.
[http://dx.doi.org/10.1016/S0140-6736(10)60676-9] [PMID: 20609987]
[5]
Seden K, Merry C, Hewson R, et al. Prevalence and type of drug- drug interactions involving ART in patients attending a specialist HIV outpatient clinic in Kampala, Uganda. J Antimicrob Chemother 2015; 70(12): 3317-22.
[http://dx.doi.org/10.1093/jac/dkv259] [PMID: 26286575]
[6]
Effros RB, Fletcher CV, Gebo K, et al. Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clin Infect Dis 2008; 47(4): 542-53.
[http://dx.doi.org/10.1086/590150] [PMID: 18627268]
[7]
Gleason LJ, Luque AE, Shah K. Polypharmacy in the HIV-infected older adult population. Clin Interv Aging 2013; 8: 749-63.
[PMID: 23818773]
[8]
Allavena C, Hanf M, Rey D, et al. Dat’AIDS study group. Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients. PLoS One 2018; 13(9): e0203895.
[http://dx.doi.org/10.1371/journal.pone.0203895] [PMID: 30240419]
[9]
Marzolini C, Livio F. Prescribing issues in elderly individuals living with HIV. Expert Rev Clin Pharmacol 2019; 12(7): 643-59.
[http://dx.doi.org/10.1080/17512433.2019.1627200] [PMID: 31155978]
[10]
Guaraldi G, Orlando G, Zona S, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis 2011; 53(11): 1120-6.
[http://dx.doi.org/10.1093/cid/cir627] [PMID: 21998278]
[11]
Justice AC. HIV and aging: time for a new paradigm. Curr HIV/AIDS Rep 2010; 7(2): 69-76.
[http://dx.doi.org/10.1007/s11904-010-0041-9] [PMID: 20425560]
[12]
Work Group for HIV and Aging Consensus Project. Summary report from the Human Immunodeficiency Virus and Aging Consensus Project: treatment strategies for clinicians managing older individuals with the human immunodeficiency virus. J Am Geriatr Soc 2012; 60(5): 974-9.
[http://dx.doi.org/10.1111/j.1532-5415.2012.03948.x] [PMID: 22568508]
[13]
Edelman EJ, Gordon KS, Glover J, McNicholl IR, Fiellin DA, Justice AC. The next therapeutic challenge in HIV: polypharmacy. Drugs Aging 2013; 30(8): 613-28.
[http://dx.doi.org/10.1007/s40266-013-0093-9] [PMID: 23740523]
[14]
Back D, Marzolini C. The challenge of HIV treatment in an era of polypharmacy. J Int AIDS Soc 2020; 23(2): e25449.
[http://dx.doi.org/10.1002/jia2.25449] [PMID: 32011104]
[15]
Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am Geriatr Soc 2014; 62(3): 447-53.
[http://dx.doi.org/10.1111/jgs.12695] [PMID: 24576251]
[16]
Greene M, Justice AC, Lampiris HW, Valcour V. Management of human immunodeficiency virus infection in advanced age. JAMA 2013; 309(13): 1397-405.
[http://dx.doi.org/10.1001/jama.2013.2963] [PMID: 23549585]
[17]
Ware D, Palella FJ Jr, Chew KW, et al. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. PLoS One 2018; 13(9): e0203890.
[http://dx.doi.org/10.1371/journal.pone.0203890] [PMID: 30204807]
[18]
Seden K, Back D, Khoo S. Antiretroviral drug interactions: often unrecognized, frequently unavoidable, sometimes unmanageable. J Antimicrob Chemother 2009; 64(1): 5-8.
[http://dx.doi.org/10.1093/jac/dkp152] [PMID: 19398457]
[19]
Molas E, Luque S, Retamero A, et al. Frequency and severity of potential drug interactions in a cohort of HIV-infected patients Identified through a Multidisciplinary team. HIV Clin Trials 2018; 19(1): 1-7.
[http://dx.doi.org/10.1080/15284336.2017.1404690] [PMID: 29179644]
[20]
Miller CD, El-Kholi R, Faragon JJ, Lodise TP. Prevalence and risk factors for clinically significant drug interactions with antiretroviral therapy. Pharmacotherapy 2007; 27(10): 1379-86.
[http://dx.doi.org/10.1592/phco.27.10.1379] [PMID: 17896893]
[21]
Kigen G, Kimaiyo S, Nyandiko W, et al. USAID-Academic Model for Prevention Treatment of HIV/AIDS. Prevalence of potential drug-drug interactions involving antiretroviral drugs in a large Kenyan cohort. PLoS One 2011; 6(2): e16800.
[http://dx.doi.org/10.1371/journal.pone.0016800] [PMID: 21373194]
[22]
Patel N, Abdelsayed S, Veve M, Miller CD. Predictors of clinically significant drug-drug interactions among patients treated with nonnucleoside reverse transcriptase inhibitor-, protease inhibitor-, and raltegravir-based antiretroviral regimens. Ann Pharmacother 2011; 45(3): 317-24.
[http://dx.doi.org/10.1345/aph.1P576] [PMID: 21386025]
[23]
Tseng A, Foisy M. Important drug-drug interactions in HIVinfected persons on antiretroviral therapy: an update on new interactions between HIV and non-HIV drugs. Curr Infect Dis Rep 2012; 14(1): 67-82.
[http://dx.doi.org/10.1007/s11908-011-0229-1] [PMID: 22125049]
[24]
Evans-Jones JG, Cottle LE, Back DJ, et al. Recognition of risk for clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis 2010; 50(10): 1419-21.
[http://dx.doi.org/10.1086/652149] [PMID: 20380564]
[25]
Iniesta-Navalón C, Franco-Miguel JJ, Gascón-Cánovas JJ, Rentero-Redondo L. Identification of potential clinically significant drug interactions in HIV-infected patients: a comprehensive therapeutic approach. HIV Med 2015; 16(5): 273-9.
[http://dx.doi.org/10.1111/hiv.12205] [PMID: 25523089]
[26]
de Maat MM, de Boer A, Koks CH, et al. Evaluation of clinical pharmacist interventions on drug interactions in outpatient pharmaceutical HIV-care. J Clin Pharm Ther 2004; 29(2): 121-30.
[http://dx.doi.org/10.1111/j.1365-2710.2003.00541.x] [PMID: 15068400]
[27]
Seden K, Bradley M, Miller AR, Beadsworth MB, Khoo SH. The clinical utility of HIV outpatient pharmacist prescreening to reduce medication error and assess adherence. Int J STD AIDS 2013; 24(3): 237-41.
[http://dx.doi.org/10.1177/0956462412472428] [PMID: 23562967]
[28]
Katende-Kyenda NL, Lubbe MS, Serfontein JH, Truter I. Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa. S Afr Med J 2008; 98(2): 109-13.
[PMID: 18350204]
[29]
Avihingsanon A, van der Lugt J, Singphore U, et al. Pharmacokinetics and 48 week efficacy of adjusted dose indinavir/ritonavir in rifampicin-treated HIV/tuberculosis-coinfected patients: a pilot study. AIDS Res Hum Retroviruses 2012; 28(10): 1170-6.
[http://dx.doi.org/10.1089/aid.2011.0247] [PMID: 22250979]
[30]
Boulle A, Van Cutsem G, Cohen K, et al. Outcomes of nevirapine- and efavirenz-based antiretroviral therapy when coadministered with rifampicin-based antitubercular therapy. JAMA 2008; 300(5): 530-9.
[http://dx.doi.org/10.1001/jama.300.5.530] [PMID: 18677025]
[31]
von Wyl V, Yerly S, Böni J, et al. Swiss HIV Cohort Study. Factors associated with the emergence of K65R in patients with HIV-1 infection treated with combination antiretroviral therapy containing tenofovir. Clin Infect Dis 2008; 46(8): 1299-309.
[http://dx.doi.org/10.1086/528863] [PMID: 18444871]
[32]
Negredo E, Moltó J, Burger D, et al. Unexpected CD4 cell count decline in patients receiving didanosine and tenofovir-based regimens despite undetectable viral load. AIDS 2004; 18(3): 459-63.
[http://dx.doi.org/10.1097/00002030-200402200-00012] [PMID: 15090798]
[33]
Seden K, Khoo SH, Back D, et al. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting. J Antimicrob Chemother 2013; 68(1): 1-3.
[http://dx.doi.org/10.1093/jac/dks346] [PMID: 22915459]
[34]
Okulicz JF, Grandits GA, French JA, et al. Infectious Disease Clinical Research Program (IDCRP) HIV Working Group. Virologic outcomes of HAART with concurrent use of cytochrome P450 enzyme-inducing antiepileptics: a retrospective case control study. AIDS Res Ther 2011; 8: 18.
[http://dx.doi.org/10.1186/1742-6405-8-18] [PMID: 21575228]
[35]
Bruce RD, Altice FL, Gourevitch MN, Friedland GH. Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications: Implications and management for clinical practice. J Acquir Immune Defic Syndr 2006; 41(5): 563-72.
[http://dx.doi.org/10.1097/01.qai.0000219769.89679.ec] [PMID: 16652030]
[36]
Agu KA, Oqua D, Adeyanju Z, et al. The incidence and types of medication errors in patients receiving antiretroviral therapy in resource-constrained settings. PLoS One 2014; 9(1): e87338.
[http://dx.doi.org/10.1371/journal.pone.0087338] [PMID: 24489899]
[37]
Jakeman B, Nasiri M, Ruth L, Morse C, Mahatme S, Patel N. Comparing the frequencies of contraindicated drug-drug interactions between differing antiretroviral regimens in HIV-infected patients. Ann Pharmacother 2017; 51(5): 365-72.
[http://dx.doi.org/10.1177/1060028016685115] [PMID: 28367698]
[38]
Patel N, Borg P, Haubrich R, McNicholl I. Analysis of drug-drug interactions among patients receiving antiretroviral regimens using data from a large open-source prescription database. Am J Health Syst Pharm 2018; 75(15): 1132-9.
[http://dx.doi.org/10.2146/ajhp170613] [PMID: 29903710]
[39]
Farhoudi M, Khalili H, Karimzadeh I, Abbasian L. Associated factors of drug-drug interactions of highly active antiretroviral therapy: report from a referral center. Expert Opin Drug Metab Toxicol 2015; 11(4): 471-9.
[http://dx.doi.org/10.1517/17425255.2014.993606] [PMID: 25557864]
[40]
Yiu P, Nguyen NN, Holodniy M. Clinically significant drug interactions in younger and older human immunodeficiency virus-positive patients receiving antiretroviral therapy. Pharmacotherapy 2011; 31(5): 480-9.
[http://dx.doi.org/10.1592/phco.31.5.480] [PMID: 21923429]
[41]
Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the international antiviral society-USA panel. JAMA 2018; 320(4): 379-96.
[http://dx.doi.org/10.1001/jama.2018.8431] [PMID: 30043070]
[42]
EACS guidelines version 100 2019.https://www.eacsociety.org/files/2019_guidelines-10.0_final.pdf
[43]
Liverpool HIV drug interactions https://www.hiv-druginteractions.org/
[44]
Smit M, Brinkman K, Geerlings S, et al. ATHENA observational cohort. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 2015; 15(7): 810-8.
[http://dx.doi.org/10.1016/S1473-3099(15)00056-0] [PMID: 26070969]
[45]
Hasse B, Ledergerber B, Furrer H, et al. Swiss HIV Cohort Study. Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis 2011; 53(11): 1130-9.
[http://dx.doi.org/10.1093/cid/cir626] [PMID: 21998280]
[46]
Goulet JL, Fultz SL, Rimland D, et al. Aging and infectious diseases: do patterns of comorbidity vary by HIV status, age, and HIV severity? Clin Infect Dis 2007; 45(12): 1593-601.
[http://dx.doi.org/10.1086/523577] [PMID: 18190322]
[47]
Mothe B, Perez I, Domingo P, et al. HIV-1 infection in subjects older than 70: a multicenter cross-sectional assessment in Catalonia, Spain. Curr HIV Res 2009; 7(6): 597-600.
[http://dx.doi.org/10.2174/157016209789973691] [PMID: 19929794]
[48]
Bastida C, Grau A, Márquez M, et al. Polypharmacy and potential drug-drug interactions in an HIV-infected elderly population. Farm Hosp 2017; 41(5): 618-24.
[PMID: 28847251]
[49]
Gimeno-Gracia M, Crusells-Canales MJ, Javier Armesto-Gómez F, Rabanaque-Hernández MJ. Prevalence of concomitant medications in older HIV+ patients and comparison with general population. HIV Clin Trials 2015; 16(3): 117-24.
[http://dx.doi.org/10.1179/1528433614Z.0000000012] [PMID: 25978302]
[50]
Marzolini C, Elzi L, Gibbons S, et al. Swiss HIV Cohort Study. Prevalence of comedications and effect of potential drug-drug interactions in the Swiss HIV Cohort Study. Antivir Ther (Lond) 2010; 15(3): 413-23.
[http://dx.doi.org/10.3851/IMP1540] [PMID: 20516560]
[51]
Baecke C, Gyssens IC, Decoutere L, van der Hilst JCH, Messiaen P. Prevalence of drug-drug interactions in the era of HIV integrase inhibitors: a retrospective clinical study. Neth J Med 2017; 75(6): 235-40.
[PMID: 28741582]
[52]
Ruzicka DJ, Imai K, Takahashi K, Naito T. Comorbidities and the use of comedications in people living with HIV on antiretroviral therapy in Japan: a cross-sectional study using a hospital claims database. BMJ Open 2018; 8(6): e019985.
[http://dx.doi.org/10.1136/bmjopen-2017-019985] [PMID: 29903786]
[53]
Córdova E, Porteiro N, Loiza E, Mingrone H. [Prevalence of potential drug-drug interactions involving antiretroviral drugs in Buenos Aires, Argentina]. Rev Chilena Infectol 2016; 33(Suppl. 1): 54-9.
[PMID: 28453027]
[54]
Schlaeppi C, Vanobberghen F, Sikalengo G, et al. Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) study group. Prevalence and management of drug-drug interactions with antiretroviral treatment in 2069 people living with HIV in rural Tanzania: a prospective cohort study. HIV Med 2020; 21(1): 53-63.
[http://dx.doi.org/10.1111/hiv.12801] [PMID: 31532898]
[55]
Kara E, İnkaya AÇ, Aydın Haklı D, Demirkan K, Ünal S. Polypharmacy and drug-related problems among people living with HIV/AIDS: a single-center experience. Turk J Med Sci 2019; 49(1): 222-9.
[http://dx.doi.org/10.3906/sag-1807-295] [PMID: 30761883]
[56]
Gebo KA, Justice A. HIV infection in the elderly. Curr Infect Dis Rep 2009; 11(3): 246-54.
[http://dx.doi.org/10.1007/s11908-009-0036-0] [PMID: 19366568]
[57]
Onen NF, Overton ET, Seyfried W, et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials 2010; 11(2): 100-9.
[http://dx.doi.org/10.1310/hct1102-100] [PMID: 20542846]
[58]
Loikas D, Wettermark B, von Euler M, Bergman U, Schenck- Gustafsson K. Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden. BMJ Open 2013; 3(5): e002378.
[http://dx.doi.org/10.1136/bmjopen-2012-002378] [PMID: 23645921]
[59]
Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt) 2014; 23(2): 112-9.
[http://dx.doi.org/10.1089/jwh.2012.3972] [PMID: 24206025]
[60]
Meade CS, Sikkema KJ. HIV risk behavior among adults with severe mental illness: a systematic review. Clin Psychol Rev 2005; 25(4): 433-57.
[http://dx.doi.org/10.1016/j.cpr.2005.02.001] [PMID: 15914265]
[61]
Justice AC, McGinnis KA, Atkinson JH, et al. Veterans Aging Cohort 5-Site Study Project Team. Psychiatric and neurocognitive disorders among HIV-positive and negative veterans in care: Veterans Aging Cohort Five-Site Study. AIDS 2004; 18(Suppl. 1): S49-59.
[http://dx.doi.org/10.1097/00002030-200401001-00008] [PMID: 15075498]
[62]
Sivasubramanian M, Mimiaga MJ, Mayer KH, et al. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample. Psychol Health Med 2011; 16(4): 450-62.
[http://dx.doi.org/10.1080/13548506.2011.554645] [PMID: 21749242]
[63]
Jiang T, Zhou X, Wang H, et al. Psychosocial factors associated with quality of life in young men who have sex with men living with HIV/AIDS in Zhejiang, China. Int J Environ Res Public Health 2019; 16(15): 2667.
[http://dx.doi.org/10.3390/ijerph16152667] [PMID: 31349674]
[64]
Holtzman C, Armon C, Tedaldi E, et al. and the HOPS Investigators. Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population. J Gen Intern Med 2013; 28(10): 1302-10.
[http://dx.doi.org/10.1007/s11606-013-2449-6] [PMID: 23605401]
[65]
Siefried KJ, Mao L, Cysique LA, et al. PAART study investigators. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS 2018; 32(1): 35-48.
[http://dx.doi.org/10.1097/QAD.0000000000001685] [PMID: 29135584]
[66]
Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of age with polypharmacy and risk of drug interactions with antiretroviral medications in HIV-positive patients. Ann Pharmacother 2013; 47(11): 1429-39.
[http://dx.doi.org/10.1177/1060028013504075] [PMID: 24285760]
[67]
Ranzani A, Oreni L, Agrò M, et al. Burden of exposure to potential interactions between antiretroviral and non-antiretroviral medications in a population of HIV-positive patients aged 50 years or older. J Acquir Immune Defic Syndr 2018; 78(2): 193-201.
[http://dx.doi.org/10.1097/QAI.0000000000001653] [PMID: 29767640]
[68]
Chen R, Chen J, Tang Q, et al. Use of comedications and potential drug-drug interactions in people living with HIV in China. J Infect Chemother 2020; 26(7): 722-8.
[http://dx.doi.org/10.1016/j.jiac.2020.04.003] [PMID: 32354599]
[69]
Núñez-Núñez M, Castañeda-Macías I, Sandoval-Fernández Del Castillo S. Potential interactions in a cohort of elderly hiv-positive patients. Farm Hosp 2018; 42(4): 163-7.
[PMID: 29959841]
[70]
Demessine L, Peyro-Saint-Paul L, Gardner EM, Ghosn J, Parienti JJ. Risk and cost associated with drug-drug interactions among aging HIV patients receiving combined antiretroviral therapy in France. Open Forum Infect Dis 2019; 6(3): ofz051.
[http://dx.doi.org/10.1093/ofid/ofz051] [PMID: 30949521]
[71]
López-Centeno B, Badenes-Olmedo C, Mataix-Sanjuan Á, et al. Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid, Spain: a population-based study. Clin Infect Dis 2019; ciz811.
[72]
World Health Organization (WHO). Updated recommendations on fırst-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV 2018.https://apps.who.int/iris/bitstream/handle/10665/277395/WHO-CDS-HIV-18.51-eng.pdf?ua=1
[73]
British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015.https://www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf
[74]
Guidelines for the use of antiretroviral agents in adults and adolescents with HIV 2019.https://files.aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf

Rights & Permissions Print Cite
Article Metrics
49
World Immunization Week
© 2024 Bentham Science Publishers | Privacy Policy