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Addressing Antiretroviral Therapy‐Associated Drug‐Drug Interactions in Patients Requiring Treatment for Opportunistic Infections in Low‐Income and Resource‐Limited Settings
Author(s) -
Chastain Daniel B.,
FrancoParedes Carlos,
Stover Kayla R.
Publication year - 2017
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/jcph.978
Subject(s) - medicine , drug , antiretroviral therapy , intensive care medicine , human immunodeficiency virus (hiv) , antiretroviral drug , pharmacotherapy , viral load , pharmacology , immunology
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.