Clinical outcomes and immune benefits of anti-epileptic drug therapy in HIV-AIDSReport as inadecuate




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BMC Neurology

, 10:44

First Online: 17 June 2010Received: 12 December 2009Accepted: 17 June 2010

Abstract

BackgroundAnti-epileptic drugs AEDs are frequently prescribed to persons with HIV-AIDS receiving combination antiretroviral therapy cART although the extent of AED use and their interactions with cART are uncertain. Herein, AED usage, associated toxicities and immune consequences were investigated.

MethodsHIV replication was analysed in proliferating human T cells during AED exposure. Patients receiving AEDs in a geographically-based HIV care program were assessed using clinical and laboratory variables in addition to assessing AED indication, type, and cumulative exposures.

ResultsValproate suppressed proliferation in vitro of both HIV-infected and uninfected T cells p < 0.05 but AED exposures did not affect HIV production in vitro. Among 1345 HIV-AIDS persons in active care between 2001 and 2007, 169 individuals were exposed to AEDs for the following indications: peripheral neuropathy-neuropathic pain 60%, seizure-epilepsy 24%, mood disorder 13% and movement disorder 2%. The most frequently prescribed AEDs were calcium channel blockers gabapentin-pregabalin, followed by sodium channel blockers phenytoin, carbamazepine, lamotrigine and valproate. In a nested cohort of 55 AED-treated patients receiving cART and aviremic, chronic exposure to sodium and calcium channel blocking AEDs was associated with increased CD4+ T cell levels p < 0.05 with no change in CD8+ T cell levels over 12 months from the beginning of AED therapy.

ConclusionsAEDs were prescribed for multiple indications without major adverse effects in this population but immune status in patients receiving sodium or calcium channel blocking drugs was improved.

AbbreviationsACTGAIDS clinical trial group

AEDanti-epileptic drug

AIDSacquired immune deficiency syndrome

ALTalanine aminotransferase

ARVantiretroviral drug

ASTaspartate aminotransferase

cARTcombination antiretroviral therapy

CCBcalcium channel blocker

CFSEcarboxyfluorescein succinimidyl ester

LFTliver function test

HIVhuman immunodeficiency virus

IQRinterquartile range

PBLperipheral blood lymphocyte

PHA-Pphytohemagglutinin-P

SACSouthern Alberta Clinic

SCBsodium channel blocker

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-10-44 contains supplementary material, which is available to authorized users.

Kathy Lee, Pornpun Vivithanaporn contributed equally to this work.

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