Addressing Antiretroviral Therapy‐Associated Drug‐Drug Interactions in Patients Requiring Treatment for Opportunistic Infections in Low‐Income and Resource‐Limited Settings

Abstract

An increasing number of human immunodeficiency virus (HIV)-infected patients are achieving virologic suppression on antiretroviral therapy (ART) limiting the use of primary and secondary antimicrobial prophylaxis. However, in low-income and resource-limited settings, half of those infected with HIV are unaware of their diagnosis, and fewer than 50% of patients on ART achieve virologic suppression. Management of comorbidities and opportunistic infections among patients on ART may lead to inevitable drug-drug interactions (DDIs) and even toxicities. Elderly patients, individuals with multiple comorbidities, those receiving complex ART, and patients living in low-income settings experience higher rates of DDIs. Management of these cytochrome P450-mediated, nonmediated, and drug transport system DDIs is critical in HIV-infected patients, particularly those in resource-limited settings with few options for ART. This article critically analyzes and provides recommendations to manage significant DDIs and drug toxicities in HIV-infected patients receiving ART.

Early Antiretroviral Therapy in AIDS Patients Presenting With Toxoplasma gondii Encephalitis Is Associated With More Sequelae but Not Increased Mortality

“…The population in our study has three notable characteristics (i) ART-naïve HIV individuals, (ii) the occurrence of TE as an influential factor on the decision to start ART early or administer treatment for the coinfections first, and (iii) a large proportion of patients who at the time of inclusion in the study already had advanced HIV/AIDS disease, with low CD4 + lymphocyte count and CD4 + /CD8 + ratio, and a high viral load. The presence of an ANI in ART-naive patients will always bring major therapeutic challenges associated with the possibility of developing immune reconstitution inflammatory syndrome (IRIS) (30,31) and complex pharmacokinetic interactions and pharmacological co-toxicities (32,33), which not only occur between ART and coinfections' treatment but also with drugs used chronically to treat other comorbidities (34,35).…”

Factores socioeconómicos y clínicos asociados con infecciones oportunistas en pacientes con HIV afiliados al sistema de salud

“…Por el contrario, el riesgo de mortalidad entre quienes no la reciben es 10 veces mayor (9). Para que el tratamiento farmacológico sea eficaz debe ser suministrado por personal altamente calificado, con el fin de evitar las interacciones medicamentosas y los efectos tóxicos que amenazan la vida de los pacientes (72). Hasta el momento, no se conocen estudios en Colombia que permitan establecer la utilización de la profilaxis para el control de las infecciones oportunistas.…”

Effects of Nicotine Exposure From Tobacco Products and Electronic Cigarettes on the Pathogenesis of Neurological Diseases: Impact on CNS Drug Delivery

“…Moreover, smokers have increased expression of CYP1A1, which can increase the metabolism ARTs that undergo metabolism through this pathway, such as dolutegravir resulting in a higher drug clearance value (Zhu et al, 2018). Nicotine has also been reported to induce UGT1A1 in HIV-infected patients and thus could directly affect the metabolism of abacavir, raltegravir, and elvitegravir that use similar enzyme metabolism systems (Chastain et al, 2017;Parant et al, 2019).…”