Pre- and Post-Exposure Prophylaxis for HIV in Patients Taking Anti-Seizure Medications-Reference-Cited by-同舟云学术

Pre- and Post-Exposure Prophylaxis for HIV in Patients Taking Anti-Seizure Medications

Published:2024-05-28 Issue:4 Volume:24 Page:219-231
ISSN:1535-7597
Container-title:Epilepsy Currents
language:en
Short-container-title:Epilepsy Curr

Author:

Kerr Wesley T.¹²³^ORCID,Gidal Barry⁴,Avedissian Sean N.⁵,McAnaney Cara⁶⁷,Wilmshurst Jo M.⁸,Eley Brian S.⁹¹⁰,Eyal Sarah¹¹^ORCID,Alick-Lindstrom Sasha¹²¹³

Affiliation:

1. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA

2. Department of Biomedical Informatics, University of Pittsburgh, PA, USA

3. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

4. Department of Neurology, University of Wisconsin, Madison, WI, USA

5. Antiviral Pharmacology Laboratory, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA

6. Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA, USA

7. National Clinician Consultation Center, University of California San Francisco, San Francisco, CA, USA

8. Department of Paediatric Neurology, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa

9. Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

10. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa

11. Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

12. Department of Neurology, University of Texas Southwestern, Dallas, TX, USA

13. Department of Radiology, University of Texas Southwestern, Dallas, TX, USA

Abstract

The prevention of human immunodeficiency virus (HIV) infection has recently emphasized the use of pre- and post-exposure prophylaxis (PrEP and PEP), both of which were highly effective in prevention of HIV infection. Since the last published guidance regarding the cotreatment of people with anti-seizure medications (ASM) and antiretroviral treatments (ARTs) in 2012, both fields have numerous new medication options. Historically, cotreatment of HIV and seizures could be challenging with increased risk of virologic failure and barriers in access to health care due to global availability, social determinants of health, and stigma of both HIV and seizures. In this narrative review, we describe the data-driven and expected bidirectional pharmacokinetic (PK) interactions between guideline-based PrEP and PEP treatment and ASM, as well as overlapping side effects. There are many ASMs with no known interaction with PrEP or PEP regimens. The interactions focus on enzyme inducing ASMs, valproate, and lamotrigine. Most prominently, enzyme inducing ASMs lower serum levels of tenofovir-containing PrEP regimens and elements of PEP (dolutegravir, raltegravir, and ritonavir), which increased risk of virologic treatment failure in people with HIV but have unclear clinical significance on the effectiveness of PrEP and PEP. In addition, ritonavir treatment in PEP may significantly lower lamotrigine serum levels even during the 4 weeks of treatment, which may increase risk for breakthrough seizures during PEP and skin reactions after discontinuation of ritonavir. In addition to PK interactions, overlapping side effects are common including osteopenia, hepatic toxicity, and other gastrointestinal effects. This narrative review aims to be a resource for all clinicians prescribing ASMs so that they can create a welcoming environment to enable successful treatment of seizures and reduce the risk of HIV infection in people at risk. In addition, we highlight knowledge gaps and areas of unmet need that can be addressed with future studies.

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/15357597241253500

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