Interactions with antiretrovirals
The majority of people living with HIV today are extremely well managed by the antiretroviral treatment they are taking and there are many combinations available (one size does not fit all).
However, they ALL have the potential of interactions with other prescribed medications. These may be medications available to purchase in the pharmacy or may also be vitamin and herbal supplements. Even common supplements like a multivitamin or indigestion/heartburn medication can affect some antiretroviral medications.
Some interactions may have impacts on other medication you may be taking for cholesterol, asthma, depression, diabetes, erectile dysfunction or other conditions. These interactions can also alter the amount, effectiveness or levels of HIV antiretrovirals in your body and change the effect your antiretroviral medication has in your body. Some interactions may mean you have higher levels of the antiretroviral drugs than needed, and you are more likely to experience adverse effects or toxicities.
Alternately, some interactions can result in you having insufficient levels of the antiretroviral drugs to control the HIV virus. This increases the risk of viral breakthrough and the development of resistance, which may compromise your HIV treatment options now and in the future. Some medications or supplements may also affect the results of some of the regular blood tests that you have.
An example is creatine which is a very popular sports supplement, which many people who go to the gym take. Creatine can affect the results of your kidney function tests, so it is important to tell your doctor if you are taking these and ANY other supplements/herbs. St John’s Wort is a commonly used herbal supplement for anxiety/depression, and it is well known that this herbal supplement interacts with many antiretrovirals and should be avoided.
A useful website (and smartphone app) that is accessible to everyone with a mobile device (iphone, ipad, etc) is the University of Liverpool HIV Drug Interaction Checker.
This app is a regularly updated database where you can enter the antiretroviral medication you are taking, and then other medications or herbs/supplements and see if there is an interaction.
It works on the traffic light system: green is good, orange means caution, and red means they definitely should NOT be combined. To note, this database is still somewhat limited for herbal medications and supplements, and some medications may be known by another name overseas.
There are far too many interactions to go into detail here, so before starting any new medication or supplement it is important to check with your HIV pharmacist or s100 prescriber to confirm the combination is suitable.
Published in Talkabout #197 June 2021