Comorbidities, comedications and potential drug–drug interactions among people living with HIV in China

OBJECTIVE: With increasing life expectancy among HIV-positive persons in China, comorbidities, polypharmacy and potential drug-drug interactions (DDIs) present growing challenges. We evaluated these issues in the integrase strand transfer inhibitor (INSTI) era of antiretroviral therapy (ART). METHODS: In this multi-site, cross-sectional study, we enrolled 5238 HIV-positive persons from four geographically diverse regions of China. Using the University of Liverpool HIV Drug Interactions Database, we categorized potential DDIs as follows: no interaction (green), weak interaction (yellow), interaction requiring dose adjustment/monitoring (amber) or contraindicated (red). RESULTS: The mean age of participants was 41.7 years; 1121 (21.4%) had at least one comorbidity. Notable treatment gaps were observed: 516 (46.0%) comorbid cases received no treatment, with particularly low treatment rates for hypertension (21.8%, 81/372), dyslipidaemia (45.3%, 86/190), diabetes (15.2%, 24/158), cardiovascular disease (23.0%, 20/87) and endocrine/metabolic disorders (58.6%, 85/142). Non-ART medication use was reported by 604 (11.5%), most commonly antihypertensives (6.1%, 320/5238), antidiabetics (3.4%, 176/5238). Among medication users, 253 (41.8%) had potential DDIs: red-flagged (1.0%, 4/604), amber-flagged (32.5%, 198/604) and yellow-flagged (8.3%, 51/604). Multivariable analysis revealed older age, overweight/obesity, urban insurance, lower income, lower CD4 counts and INSTI-based regimens were positively associated with comorbidities and comedication use. Potential DDI risk increased with older age, longer ART duration, smoking, polypharmacy and non-nucleoside reverse transcriptase inhibitors/protease inhibitor-based regimens. CONCLUSIONS: Our findings reveal high comorbidity prevalence with significant treatment gaps and frequent potential DDIs among Chinese HIV-positive persons, particularly involving cardiometabolic medications and non-INSTI ART regimens. These results underscore the urgent need for integrated HIV/chronic care models incorporating routine DDI screening to improve clinical outcomes.