Drug–drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems

Abstract

Introduction Substance abuse is a common problem among HIV-infected individuals. Importantly, addictions as well as moderate use of alcohol, smoking, or other illicit drugs have been identified as major reasons for non-adherence to antiretroviral therapy (ART) among HIV patients. The literature also suggests a decrease in the response to ART among HIV patients who use these substances, leading to failure to achieve optimal virological response and increased disease progression. Areas covered This review discusses the challenges with adherence to ART as well as observed drug interactions and known toxicities with major drugs of abuse, such as alcohol, smoking, methamphetamine, cocaine, marijuana, and opioids. The lack of adherence and drug interactions potentially lead to decreased efficacy of ART drugs and increased ART, and drugs of abuse-mediated toxicity. As CYP is the common pathway in metabolizing both ART and drugs of abuse, we discuss the possible involvement of CYP pathways in such drug interactions. Expert opinion We acknowledge that further studies focusing on common metabolic pathways involving CYP and advance research in this area would help to potentially develop novel/alternate interventions and drug dose/regimen adjustments to improve medication outcomes in HIV patients who consume drugs of abuse.

Efeito do álcool em pessoas com HIV: tratamento e qualidade de vida

“…Thus, these consumers may be at increased risk of toxicity and ineffective therapy due to inadequate concentrations of the drug in plasma. (26) The present study identified a statistical association between risky alcohol use and the Physical and Social Relations domains of the WHOQOL-HIV Bref instrument, similar to another study. (18) The Physical domain evaluates the pain, discomfort, energy, fatigue, sleep, and rest of PLWHA, while the Social Relations domain evaluates the personal relationships, social support, sexual activity, and social inclusion of these individuals.…”

Recreational Drugs and Antiretrovirals: Is It Worth the World or Trivial?

“…Substratlar, CYP3A4'ü inhibe edici, indükleyici veya her iki yönde etki gösterebilmektedir [16,23,24] . Keyif verici maddeler, metabolize oldukları enzimler ve bu enzimler üzerindeki inhibitör veya indükleyici etkileri göz önüne alındığında, ARV anlamlı düzeyde etkileşebilir; tedavi başarısızlığı veya toksisiteye neden olabilir [25] .…”

“…Antiretroviral ilaçlar efluks taşıyıcıların sadece substratı değil aynı zamanda inhibitörü ve indükleyicisi olabilmektedirler. Efluks taşıyıcıların inhibe edilmesi; istenmeyen yan etkilere ve toksisiteye neden olabilir, indüksiyonu ise tedavi etkinliğinin azalmasına neden olabilir [16] . Antiretroviral bileşikler enzimlerin ve taşıyıcı proteinlerin substratı olması açısından üç ana gruba ayrılabilir:…”

“…HIV enfeksiyonu tedavisinde sağlanan başarı sayesinde enfekte bireylerin daha uzun süre yaşaması mümkün olmuştur. Öte yandan, yaşam süresindeki artış, HIV'in santral sinir sistemindeki etkilerinin (nöro-AIDS) belirgin hale gelmesine de yol açmaktadır [15,16] . Nöro-AIDS gelişimi, enfekte kişilerde madde kullanımını daha da artırabilmektedir.…”

Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

“…In addition, providers may need to know about concurrent substance use with ART to avoid drug interactions. 16,17 Importantly, cessation of both alcohol and illicit drug use is associated with rapid improvement in ART adherence, viral load, and CD4 counts, and decreased risk of opportunistic infections, suggesting that provider substance use counseling may have important therapeutic implications. 5,7 Despite this, providers often fail to elicit information about substance use, both in general outpatient settings and in HIV care.…”