Abstract
Objective: To develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS.
Methods: The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED-ARV interactions.
Results and Recommendations: AED-ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of ∼50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations (Level C). Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment (Level C). Patients receiving ritonavir/atazanavir may require a lamotrigine dosage increase of ∼50% to maintain unchanged lamotrigine serum concentrations (Level C). Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment (Level C). Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment (Level C). Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined (Level U). It may be important to avoid enzyme-inducing AEDs in people on ARV regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen (Level C).
GLOSSARY
- AED=
- antiepileptic drug;
- ARV=
- antiretroviral agent;
- AUC=
- area under the serum concentration-time curve;
- CI=
- confidence interval;
- EI=
- enzyme-inducing;
- NNRTI=
- nonnucleotide reverse transcriptase inhibitor;
- PI=
- protease inhibitor;
- VL=
- viral load
Footnotes
Appendices e-1–e-6, tables e-1–e-4, and References e1–e18 are available on the Neurology® Web site at www.neurology.org.
Approved by the Quality Standards Subcommittee on February 19, 2011; by the Practice Committee on June 6, 2011; and by the AAN Board of Directors on September 2, 2011.
Study funding: This guideline was developed with financial support from the American Academy of Neurology and the International League Against Epilepsy. None of the authors received reimbursement, honoraria, or stipends for their participation in development of this guideline.
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Supplemental data at www.neurology.org
- Received June 6, 2011.
- Accepted September 7, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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