424. Safety of Intravenous (IV) Midazolam for Procedural Sedation in HIV-infected Patients on Antiretroviral Therapy (ART)
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Background: Midazolam (MDZ) is a short-acting agent with good amnestic properties.  However, because of concerns regarding interactions between MDZ and antiretroviral therapy (ART), diazepam (DZP), a drug with fewer interactions, is sometimes used instead for procedural sedation in HIV-infected patients.  We compared outcomes of HIV-infected patients on ART who received IV MDZ vs. IV DZP during colonoscopy.

Methods: Data from 136 adult HIV+ patients on ART who underwent colonoscopy over a 3.5 year period were evaluated in a retrospective study. We compared sedation duration, lowest systolic blood pressure (SBP), respiratory rate, consciousness score (using a standardized scale on which score of 1 means arousable or disoriented) and rate of abnormal cardiac rhythm between those receiving MDZ and DZP, by performing univariate and multivariate analyses. 

Results: Patients who received MDZ (n=70) had similar baseline characteristics as those who received DZP (n=66), although a greater proportion in the MDZ group had liver disease (mostly viral hepatitis) compared to the DZP group (31% vs. 17%, P=0.0447). We did not find significant differences between the MDZ and DZP groups in sedation duration (53.4 vs. 51.3 min, P=0.69), lowest SBP (95.1 vs. 98.4, P=0.10) or lowest respiratory rate (15.8 vs. 15.7, P=0.63). More patients in the MDZ group experienced a depressed level of consciousness (defined as consciousness score=1, 91% vs. 74%, P=0.0075); no patient in either group became unresponsive.  Those receiving DZP were more likely to have abnormal cardiac rhythm (20% vs. 11%), but none required treatment and the difference between groups did not reach statistical significance (OR=2.1, 95% CI (0.78; 5.62). Mean MDZ dose was 4.1 +/- 1.2 mg (0.05 +/- 0.02 mg/kg) with a mean initial bolus dose of 2 +/- 0.2 mg.

Conclusion: Although IV MDZ can interact with ART, we did not find statistically significant evidence that patients who received this agent for procedural sedation had clinical outcomes different from those who received DZP. These findings should be confirmed in prospective studies or in randomized controlled trials settings. 

Subject Category: H. HIV/AIDS and other retroviruses

Elke Backman, PharmD1, Ehrenfeld Jesse, MD, MPH2, Virginia Triant, MD, MPH1, Paul Arpino, PharmD1, Zhigang Lu, MD1, Elena Losina, PhD3 and Rajesh Gandhi, MD, FIDSA1, (1)Massachusetts General Hospital, Boston, MA, (2)Vanderbilt University School of Medicine, Nashville, TN, (3)Massachusetts General Hospital, Boston University School of Public Health, Boston, MA


E. Backman, None

E. Jesse, None

V. Triant, None

P. Arpino, None

Z. Lu, None

E. Losina, None

R. Gandhi, Tibotec: Grant Investigator, Grant recipient
Gilead: Grant Investigator, Educational grant

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.