D. M. Burger

Introduction The large number of deaths among children with HIV is driven by poor antiretroviral treatment (ART) coverage among this cohort. The aim of the study was to assess the availability and stock‐outs of paediatric and adult ART formulations in Kenya and Uganda across various regions and types of health facilities. Methods A survey on availability and stock‐outs of paediatric ART at health facilities was adapted from the standardized Health Action International–WHO Medicine Availability Monitoring Tool. All preferred and limited‐use formulations, and three phased‐out formulations according to the 2021 WHO optimal formulary list were included in the survey, as well as a selection of adult ART formulations suitable for older children, adolescents, and adults. Availability data were collected in June–July 2022 and stock‐out data were obtained over the previous year from randomly selected public and private‐not‐for‐profit (PNFP) facilities registered to dispense paediatric ART across six districts per country. All data were analysed descriptively. Results In total, 144 health facilities were included (72 per country); 110 were public and 34 PNFP facilities. Overall availabilities of preferred paediatric ART formulations were 52.2% and 63.5% in Kenya and Uganda, respectively, with dolutegravir (DTG) 10 mg dispersible tablets being available in 70.2% and 77.4% of facilities, respectively, and abacavir/lamivudine dispersible tablets in 89.8% and 98.2% of facilities. Of note, availability of both formulations was low (37.5% and 62.5%, respectively) in Kenyan PNFP facilities. Overall availabilities of paediatric limited‐use products were 1.1% in Kenya and 1.9% in Uganda. At least one stock‐out of a preferred paediatric ART formulation was reported in 40.0% of Kenyan and 74.7% of Ugandan facilities. Nevirapine solution stock‐outs were reported in 43.1% of Ugandan facilities, while alternative formulations for postnatal HIV prophylaxis were not available. Conclusions Recommended DTG‐based first‐line ART for children across all ages was reasonably available at health facilities in Kenya and Uganda, with the exception of Kenyan PNFP facilities. Availability of paediatric ART formulations on the limited‐use list was extremely low across both countries. Stock‐outs were reported regularly, with the high number of reported stock‐outs of neonatal ART formulations in Uganda being most concerning.

Background and objectives Obesity trends and metabolic dysregulation are rising in people living with HIV using antiretrovirals (ARVs). Underlying causes and preventive strategies are being investigated. Two glucagon like‐peptide 1 (GLP‐1) agonists, liraglutide and semaglutide, were formerly approved as glucose‐lowering drugs and have been recently approved for long‐term weight loss in people with obesity. Due to the lack of therapeutic guidelines or clinical trials in people with HIV, we discuss the potential benefits, safety aspects and pharmacological considerations of prescribing liraglutide and semaglutide in people with HIV. Results Clinical experience is limited to two clinical cases of diabetic people with HIV using liraglutide after which a successful weight loss and glycaemic control were observed. None of the adverse events associated with liraglutide and semaglutide usage indicate an additional risk for people with HIV. Extra caution showed be warranted when initiating GLP‐1 agonist therapy in people with HIV taking protease inhibitors who have pre‐existing risk factors for heart rate variability to reduce the incidence of RP interval prolongation. GLP‐1 agonists are metabolized by endopeptidases, and thus do not generate major drug–drug interactions with most drugs, including ARVs. GLP‐s agonists are known to inhibit gastric acid secretion, which warrants caution and close monitoring when combined with atazanavir and oral rilpivirine, two ARVs that require low gastric pH for an optimal absorption. Conclusion Theoretical considerations and a few available clinical observations support semaglutide and liraglutide prescription in people with HIV, with, thus far, no indications of concern regarding efficacy, safety or pharmacological interactions with ARVs.

Objective Lower urinary tract symptoms (LUTS) are becoming more prevalent in the ageing population of males living with HIV. Drugs to treat LUTS are known for both their potential role as victims in drug–drug interactions (DDIs) and their side effects. We aimed to evaluate the current use of drugs to treat LUTS and to assess potential DDIs in our cohort of adult males living with HIV. Design This was a retrospective review of pharmacy records. Methods We recorded the combination antiretroviral therapy (cART) regimen and any use of drugs to treat LUTS (anatomical therapeutic chemical codes G04CA/CB/CX and G04BD). Potential DDIs were assessed using the interaction checker developed by the University of Liverpool ( https://www.hiv-druginteractions.org/checker ). Results A total of 411 adult males living with HIV were included in this analysis. The median (interquartile range [IQR]) age was 53 (41–62) years. Nineteen (4.6%) patients used one or more drugs to treat LUTS. As expected, older patients were more likely to be receiving treatment for LUTS: Q1 (20–40 years) = 0%; Q2 (41–52 years) = 2%; Q3 (53–61 years) = 7%; Q4 (62–79 years) = 10%. Seven potential DDIs between cART and LUTS treatment were noted in six of the 19 (32%) patients. Following medication reviews of these six patients, the following interventions were proposed: evaluate safe use of alpha‐blocker ( n = 4), change in cART ( n = 2), and dose reduction of the anticholinergic agent ( n = 1). Conclusion Treatment for LUTS coincided with cART in 7%–10% of patients aged above the median age of 53 years in our cohort. Improvements in DDI management appeared to be possible in this growing cohort of males living with HIV and with LUTS.