American Academy of Neurology and International League against Epilepsy release guidelines for the use of antiepileptic drugs in patients with HIV/AIDS

Clinicians are urged to be cautious when selecting an antiepileptic drug (AED) for patients with HIV/AIDS, according to new evidence-based guidelines developed by the American Academy of Neurology (AAN) and the International League Against Epilepsy (ILAE).

According to AAN and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the ILAE, seizure disorders are common in HIV-infected or AIDS individuals, with incidence rates reported to be as high as 11% in this population.

Seizures in HIV/AIDS patients are often due to presence of opportunistic infections of the central nervous system and may require AED treatment. In addition, AEDs are being used more frequently for non-seizure indications (ie, peripheral neuropathies, psychiatric disorders). For these reasons, the 2 organizations believe "worldwide the concurrent use of AEDs and antiretroviral drugs (ARV) is substantial;" with AED coadministration occurring in more than half of the individuals taking ARVs.

Through a systematic review of the literature, the guideline committee found cohort and pharmacokinetic studies indicating that enzyme-inducing (EI) AEDs interact with ARVs, albeit, few studies evaluated drug interactions between newer ARV agents and AEDs. Upon review of this literature, the AAN and ILAE are now recommending the following:

The authors of the guidelines also emphasized, "The optimal choice of epilepsy treatment in patients with HIV should reflect an accounting for the metabolic and inhibitory/inducing profiles of coadministered drugs."

The guidelines concluded by encouraging clinicians who prescribe ARVs and AEDs to consult the US Department of Health and Human Services treatment guidelines for HIV/AIDS, which provide specific recommendations for the management of possible drug-drug interactions with AED-ARV combinations.

SOURCES

Birbeck GL, French JA, Perucca E, Simpson DM, et al. Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy. Neurology. 2012;78:139–145.

Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. October 14, 2011; 1–167. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed December 31, 2011.