Potential drug‐drug interactions in HIV‐infected children on highly active antiretroviral therapy in Lagos, Nigeria

Objective Multiple therapies are common in HIV‐infected children on highly active antiretroviral therapy (HAART). These children are at risk for clinically significant drug interactions (CSDIs). While CSDIs are under‐recognized in developed countries, data are lacking for developing African countries. We aimed to investigate the prevalence of CSDIs between antiretrovirals (ARVs) and co‐prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. Methods We retrospectively assessed the risk for clinically significant drug interactions in children on HAART. Of the 417 patients enrolled for treatment, 80 were eligible for inclusion. We defined CSDIs as ‘major’ (capable of causing severe or permanent damage, contraindicated, avoid or not recommended by the manufacturer, or requiring dose modification) or ‘moderate’ (manufacturers advise caution, or close monitoring, or capable of causing clinical deterioration). Results A total of 60 (75%) patients were at risk for a CSDI resulting in major interactions in 13 (16.3%) patients and could potentially lower the plasma concentration of antiretroviral drugs in 9 (15%) patients. Major interactions most frequently involved rifampicin in 9 (11.3%) patients and artemisinin combination therapies (ACTs) in 8 (10%) patients whereas moderate interactions frequently involved ACTs (48.8%), fluconazole (36.3%), and rifampicin (11.3%). Age (p = 0.392), gender (p = 0.813), and moderate (p = 0.692) or severe (p = 0.788) malnourished state of the children were not associated with risk for CSDIs. Conclusions Three‐quarters of children receiving ARV drugs are at risk for CSDIs. Strategies are needed to be put in place to prevent important drug interactions and to manage unavoidable interactions.