Evaluation of potential changes in prescribing patterns through the use of an HIV interactions checker database

26 Background: People ageing with HIV often experience comorbidities and polypharmacy, leading to a higher risk for adverse events and drug–drug interactions (DDIs). On the other hand, contemporary antiretrovirals have a lower potential for DDIs which may, in turn, have an impact on the treatment of common comorbidities (e.g., cardiovascular, mental diseases and opportunistic infections). We aimed to evaluate potential changes in prescribing patterns by analysing DDI queries over a 5-year period of time. Material and methods: An extraction of DDI queries was performed on the HIV interaction checker of the University of Liverpool (https://www.hiv-druginteractions.org) between 1 January 2020 and 31 December 2024. The antiretroviral drug name, co-medication class, co-medication name, interaction colour and the country of origin were collected and sorted by year. Interaction colours were defined as green (no interaction), yellow (potential interaction of weak clinical relevance), amber (potential clinically relevant interaction managed with clinical monitoring or dose adjustment) and red (deleterious interaction). Results: A total of 7 274 301 queries from 48 countries were recorded on the website with an increase of 441% from 2020 to 2024. The main users of the checker were from the UK (46.7%) and United States (34%) followed by Spain (2.7%), Brazil (2.4%) and Australia (1.8%). Overall, the most frequently searched antiretrovirals were dolutegravir (21%), bictegravir (20%), emtricitabine/tenofovir (TDF or TAF) (17.8%), darunavir with ritonavir or cobicistat (11.1%) and raltegravir (3.7%). From 2020 to 2024, an increase in queries for bictegravir (+11.3% points), dolutegravir (+7% points), cabotegravir (+3% points) and doravirine (+2.3% points) was observed, in contrast with darunavir (−4.2% points), raltegravir (−3% points) and elvitegravir (−2.9% points). The top10 searched therapeutic classes were antibacterials (9.3%), lipid lowering agents (9.4%), herbals/supplements/vitamins (9.1%), gastrointestinal agents (7.9%), analgesics (6.6%), antidepressants (6.2%), anti-coagulant/anti-platelets (4.9%), hypertension/heart failure agents (4.8%), anticonvulsants (4.3%) and steroids (4.1%). Overall, the prevalence of queries with green, yellow, amber and red colour coding was 76.6%, 4.6%, 14.9% and 4.0%, respectively. Among amber DDIs, queries involved mainly darunavir (26.0%), dolutegravir (19.6%) bictegravir (15.4%) together with herbals/supplements/vitamins (19.2%), lipid lowering agents (13.9%) or antidiabetics (9.3%). Among red DDIs, queries involved mainly darunavir (31%), bictegravir (19.4%) and elvitegravir/cobicistat (11.1%) together with gastrointestinal agents (15.7%), steroids (14.5%) and antibacterials (14.4%). In 2024, compared to 2023, a decrease in rifampicin queries was reported (−53%), as for rosuvastatine (−25%), omeprazole (−33%), pantoprazole (−33%), apixaban (−25%), warfarine (−33%) and rivaroxaban (−51%). From 2020 to 2024, a transition of amber (−5.9% points) or red (−3.1% points) DDIs to green (+9.1 points) DDIs was observed. Conclusions: Over the 2020–2024 period, we observed a substantial increase in DDI queries, suggesting that the DDI checker is increasingly integrated in clinical practice. We observed a reduction in the severity of DDIs in the recent years which likely explained by the broader use of contemporary antiretrovirals with a favourable DDI profile (i.e., dolutegravir, bictegravir, cabotegravir or doravirine).