Use of AEDs that decrease ARV levels may lead to virologic failure, resulting in immunologic decline, clinical disease progression, and development of ARV resistance. Because first line AED Dapagliflozin availability in most low and middle ome countries is limited to phenobarbital, carbamazepine, and phenytoin, and ARV regimen options may also be limited, there is substantial risk for occurrence of clinically important drug interactions.10,11 The panel asked the following questions: In people treated with ARVs for HIV/AIDS who also have conditions requiring AED use, does concurrent treatment with AEDs and ARVs lead to drug interactions? If so, are these interactions clinically meaningful? The panel also performed a systematic literature review to estimate the worldwide prevalence of potential co usage of AEDs and ARVs.
DESCRIPTION OF THE ANALYTIC PROCESS Panel selection. Given the topic’s global relevance, the AAN Quality Standards Subcommittee formed a joint panel with the International League Against Epilepsy via the World Health Organization SRC Signaling Pathway . The AAN guideline development processes are consistent with those required by WHO.12 Literature search. To estimate the worldwide prevalence of potential co usage of AEDs and ARVs, a literature search without language restrictions was conducted using MEDLINE, Cochrane Database, Web of Science, and EMBASE and the following strategy: and and . Given the prevalence of HIV associated neuropathies in low ome countries and use of AEDs to treat neuropathic pain, we luded neuropathy in the search.
ion milling Because of the dearth of data and the potential clinical value of this information regarding specific AED ARV combinations, details from case reports and uncontrolled series are provided in the evidence and summary tables. To determine potential drug– drug interactions between AEDs and ARVs, a comprehensive list of AEDs and ARVs was developed . Using this list, the panel performed the following search : drug interaction and and . The authors’ literature files were also hand searched for potentially relevant articles. Literature review. The broad search yielded 4,480 articles with potential data . At least 2 panelists reviewed the resulting articles’ titles and abstracts. Additional publications identified during review of selected articles were also obtained. The full article of any abstract deemed relevant was reviewed.
At least 2 panelists independently reviewed 68 full articles. Of these, 42 articles were used for data abstraction using the elements listed below for each question. Where data abstraction findings from the 2 panel reviewers differed, a third panelist reviewed the primary source. Data are presented in tables e 2 and e 3. The original and updated search strategies are provided in appendices e 1 and e 2. Findings in the systematic review of co usage of AEDs and ARVs. Three Class III studies suggest that 2.6%–6.1% of people with HIV will experience a new onset seizure, with most of these receiving AED treatment, at least initially. 1,2,13,14 Three Class III studies indicate that peripheral neuropathy symptoms occur in 6.7%–52.5% of individuals infected with HIV who have not yet initiated ARV therapy, with the highest rates in advanced HIV and in low and middle ome countries where dietary deficiencies.