Clinical outcomes and immune benefits of anti-epileptic drug therapy in HIV/AIDS

• Main Authors: Krentz Hartmut B, Siemieniuk Reed A, Vivithanaporn Pornpun, Lee Kathy, Maingat Ferdinand, Gill M John, Power Christopher
• Format: Article
• Language: English
• Published: BMC 2010-06-01
• Series: BMC Neurology
• Online Access: http://www.biomedcentral.com/1471-2377/10/44

<p>Abstract</p> <p>Background</p> <p>Anti-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.</p> <p>Methods</p> <p>HIV 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.</p> <p>Results</p> <p>Valproate suppressed proliferation <it>in vitro </it>of both HIV-infected and uninfected T cells (<it>p <</it>0.05) but AED exposures did not affect HIV production <it>in vitro</it>. 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 (<it>p <</it>0.05) with no change in CD8+ T cell levels over 12 months from the beginning of AED therapy.</p> <p>Conclusions</p> <p>AEDs 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.</p>