Antiepileptic Drug Interactions in HIV-Affected Patients
Summary
Seizures affect a substantial proportion of people living with HIV, arising from direct viral effects on the central nervous system, opportunistic infections and metabolic disturbances. The advent of highly active antiretroviral therapy (HAART) has transformed HIV into a chronic condition, shifting the clinical focus towards long-term comorbidities, including epilepsy. Concurrent administration of antiepileptic drugs (AEDs) and antiretrovirals introduces a complex web of pharmacokinetic and pharmacodynamic interactions. First-generation AEDs often induce or inhibit the cytochrome P450 system, leading to subtherapeutic antiretroviral levels, virologic failure or increased toxicity. Conversely, certain antiretrovirals can alter AED concentrations, heightening seizure risk or adverse events. The choice of AED must balance seizure control, drug-interaction potential, tolerability and local resource availability. Newer non-enzyme-inducing agents offer improved safety but may be limited by cost or access in resource-constrained settings. Therapeutic drug monitoring, multidisciplinary management and tailored clinical protocols are essential to preserve virologic suppression, prevent neurological morbidity and enhance quality of life worldwide.
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Antiepileptic Drug Interactions in HIV-Affected Patients publication trend
The graph below shows the total number of articles in antiepileptic drug interactions in hiv-affected patients across all publications each year (not limited to Nature Index journals).
Technical terms
Cytochrome P450 system: A family of liver enzymes responsible for the metabolism of many drugs, including antiepileptics and antiretrovirals.
Enzyme-inducing AEDs: Antiepileptic drugs that increase the activity of metabolic enzymes, potentially reducing plasma levels of co-administered medications.
Non-enzyme-inducing AEDs: Antiepileptic drugs with minimal impact on metabolic enzymes, leading to fewer clinically significant drug–drug interactions.
HAART: Combination antiretroviral therapy designed to suppress HIV replication, preserve immune function and prevent the emergence of resistance.
Virologic failure: The inability to achieve or maintain suppression of HIV viral load below the limit of detection during antiretroviral treatment.
References
- Virologic outcomes of HAART with concurrent use of cytochrome P450 enzyme-inducing antiepileptics: a retrospective case control study. AIDS Research and Therapy (2011).
- Epilepsy management in pregnant HIV+ women in sub-Saharan Africa, clinical aspects to consider: a scoping review. BMC Medicine (2020).
- Seizure in HIV-infected patients: clinical presentation, cause and treatment outcome in Ethiopia—a retrospective study. BMC Infectious Diseases (2021).
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