Anti-HIV drugs (anti-HIV) drugs reduce morbidity and mortality from HIV infection and reduce transmission of the virus. The number of people taking anti-HIV drugs is increasing, and patients may have other diseases that require other drugs to be used at the same time, so will the drugs "fight" with each other in the body?
The following is a recommended drug interaction applet, which is easy to use~
Anti-HIV drugs available in the country
Nucleoside reverse transcriptase inhibitors (NRTIs) include:
tenofovir disoproxil (TDF), lamivudine (3TC), zidovudine (AZT), and abacavir (ABC);
Non-nucleoside reverse transcriptase inhibitors (NRTIs) include:
efavirenz (EFV), nevirapine (NVP), and rilpivirine (RPV),
Protease inhibitors (PIs) include:
lopinavir ritonavir (LPV/r), darunavir cobicistat (DRV/c)
Integrase inhibitors (INSTIs) include:
dolutegravir (DTG) and raltegravir (RAL), averelvir cobicistat (EVG/c), bictegravir (BIC).
Anti-HIV drugs and gastrointestinal drugs
Antacids (such as aluminum hydroxide or magnesium, calcium carbonate, etc.) can reduce the area under the plasma concentration-time curve (AUC) of RPV in integrase inhibitors DTG, RAL, EVG/c, BIC and non-nucleoside reverse transcriptase inhibitors, and it is recommended to adjust the dosing time. For multivalent ionic drugs containing magnesium, aluminum, and calcium, integrase inhibitors should be given at least 2 hours before or 6 hours after these drugs are given.
H2 receptor antagonists (eg, cimetidine, ranitidine, and famotidine) and proton pump inhibitors (eg, omeprazole and rabeprazole) can also decrease the AUC of RPV. RPV cannot be used concomitantly with proton pump inhibitors.
Anti-HIV drugs and traditional Chinese medicine
St. John's wort (St. John's wort) has no significant interaction with ABC, 3TC, TDF, and AZT, and may reduce the levels of all protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitor drugs, and should be avoided concomitantly. There are relatively few research data on traditional Chinese medicine, so consult medical professionals when using it.
Anti-moxa drugs and methadone
1. NRTI: When TDF, 3TC and ABC are used concurrently with methadone, there is no need to adjust the dose. When AZT and methadone are used together, the AUC of AZT increases, and toxicity such as the myelosuppressive effect of AZT should be observed.
2. nNRTI: NVP and EFV can reduce methadone AUC, and it is often necessary to increase the methadone dose. RPV can reduce methadone blood levels by 16% but does not require dose adjustment.
3. PI: LPV/r and reduce methadone AUC by 26%~53%, but withdrawal symptoms are uncommon, pay attention to clinical monitoring, and increase the dose of methadone if necessary. When DRV/c and methadone are used at the same time, there is no need to adjust the dose, and attention should be paid to monitoring.
4. INSTI: No dose adjustment is required when the integrase inhibitors DTG, RAL, BIC or EVG/c are used concomitantly with methadone.
Anti-HIV drugs and anti-tuberculosis drugs
1. NRTI: When TDF, 3TC and ABC are used with the anti-tuberculosis drugs rifampicin (R), isoniazid (H), pyrazinamide (Z), ethambutol (E), neither class of drugs needs to adjust the dose. Rifampicin reduced AUC by 43% in AZT and required monitoring or dose adjustment.
2. nNRTI: rifampicin can reduce the drug level of EFV by 20%-30%, both are used in combination with the standard dose, rifampicin can reduce the blood concentration level of NVP and RPV by more than 58%, and should not be used at the same time. EFV reduced rifabutin levels by 38%, and when used at the same time, the dose of rifabutin was increased to 450 mg per day, and the standard dose of EFV was 600 mg. When NVP and rifabutin are used at the same time, rifabutin AUC is mildly increased and NVP levels decrease by 16%, but dose adjustment is usually not required. Rifabutin reduces the AUC of RPV by 42% and should not be used concurrently, if combined, the dose of RPV should be increased from 25 mg once daily to 50 mg once daily.
3. PI: rifampicin can reduce the AUC of DRV/c and LPV/r, and it is not recommended to use it at the same time. If LPV/r and rifampicin must be used together, a double dose is used for LPV/r. When rifabutin is used with LPV/r, the AUC of rifabutin increases and the dose needs to be reduced to 150 mg/day. When rifabutin and DRV/c are used together, the blood level of rifabutin increases, the AUC of DRV/c decreases, and the dose is adjusted closely or as appropriate.
4. INSTI: Combined with rifampicin, the drug levels of DTG and RAL decreased, and the dose of DTG was increased to 50 mg twice a day, and the dose of RAL was increased to 800 mg twice a day. Rifampicin can cause a significant decrease in the AUC of BIC and EVG/c, so it should not be used at the same time. There was no significant interaction between DTG and rifabutin. RAL can increase the AUC level of rifabutin, and the dose of rifabutin needs to be reduced to 150 mg/day; when rifabutin is combined with EVG/c, the AUC of EVG/c decreases and the level of rifabutin increases, so it is not recommended to use it together, and the monitoring should be strengthened when combined, and the dosage of rifabutin should be reduced if necessary. Rifabutin reduced the AUC of BIC by 38%, and BIC, FTC and TAF formed a single tablet compound preparation, and rifabutin would affect TAF absorption and could not be used together.
Among the rifamycin-based drugs, rifampicin reduced the AUC of polyanti-moxa drugs, and rifabutin had a relatively small effect on anti-moxa. When anti-HIV or antituberculous therapy is required, rifabutin can be used instead of rifampicin to form an intensive regimen or an antituberculous regimen without rifamycin.
抗艾药与丙肝直接抗病毒药物（DAA）
AZT, 3TC, and ABC in NRTI and DTG and RAL in INSTI have no or only minor interactions with all DAAs and do not require dose adjustment when used concurrently. The interaction between LPV/r and dalatasvir, sofosbuvir and sofosbuvir velpatasvir has no clinical significance and does not require adjustment of drug methods, and the interaction with other DAAs is obvious, so it is not suitable to be used at the same time (see the table below). Because anti-HIV drugs are a combination of more than 3 kinds of drugs, there are individual differences in infected people, and if there is serious discomfort in the process of taking DAA, seek medical attention in time and consult professionals for treatment opinions.
Interactions between drugs for various common diseases and self-financed antivirals
This article summarizes the interactions between drugs for various common diseases, including antibacterial, antifungal, antituberculosis, antiviral (except HIV), antipyretic analgesics, lipid-lowering drugs, hypoglycemic drugs, antihypertensive drugs, anticonvulsants, antiarrhythmic drugs, antipsychotics, and antidepressants, and the self-financed ARV drugs mentioned above, to help specialists fully consider the patient's current medication and avoid potential risks when choosing a self-funded anti-HIV drug regimen.
Red means that it is forbidden to use it
Orange indicates the presence of a potential interaction that may require dose adjustment
Yellow indicates that there may be some interaction and that additional monitoring or dose adjustment may be less necessary
Green indicates that there is no interaction between the two and no additional testing or dose adjustment is required
1. Antimicrobial interactions with ARV drugs
备注:Amoxillin:阿莫西林;Azithromycin:阿奇霉素;Ciprofloxacin:环丙沙星;Clindamycin:克林霉素;Imipenem/Cilastatin:亚胺培南/西司他丁;Meropenem:美罗培南;Metronidazole:甲硝唑;Trimethoprim/Sulfamethoxazole:甲氧苄氨嘧啶/磺胺甲恶唑; Vancomycin:万古霉素
2. Antifungal drugs interact with ARV drugs
备注:Amphotericin B:两性霉素B;Caspofungin:卡泊芬净;Fluconazole:氟康唑;Flucytosine:氟胞嘧啶;Itraconazole:伊曲康唑;Ketoconazole:酮康唑;Voriconazole:伏立康唑
3. Anti-tuberculosis drug interaction with ARV drugs
备注:Ethambutol:乙胺丁醇;Isoniazid:异烟肼;Pyrazinamide:吡嗪酰胺;Rifabutin:利福布汀;Rifampicin:利福平;Rifapentine:利福喷丁;Streptomycin:链霉素
4. Antiviral drugs interact with ARV drugs
备注:Acyclovir:阿昔洛韦; Famciclovir:泛昔洛韦; Ganciclovir:更昔洛韦; Glecaprevir/Pibrentasvir:格来普韦/哌仑他韦;Ledipasvir/Sofosbuvir:雷迪帕韦/索磷布韦; Oseltamivir:奥司他韦; Ribavirin:利巴韦林; Sofosbuvir:索磷布韦; Sofosbuvir/Velpatasvir:索磷布韦/维帕他韦;Sofosbuvir/Velpatasvir/Voxilaprevir:索磷布韦/维帕他韦/伏西拉普瑞韦;Valacyclovir:伐昔洛韦
5. Antipyretic analgesics interact with ARV drugs
备注:Aspirin:阿司匹林;Codeine:可待因;Fentanyl:芬太尼;Ibuprofen:布洛芬;Methadone:美沙酮;Morphine:吗啡;Paracetamol:对乙酰氨基酚
6. Lipid-lowering drugs interact with ARV drugs
备注:Atorvastatin:阿托伐他汀;Fluvastatin:氟伐他汀;Lovastatin:洛伐他汀;Pitavastatin:匹伐他汀;Pravastatin:普伐他汀;Rosuvastatin:瑞舒伐他汀;Simvastatin:辛伐他汀
7. Hypoglycemic drugs interact with ARV drugs
备注:Glibenclamide(Glyburide):格列本脲(优降糖);Gliclazide:格列齐特;Metformin:二甲双胍
8. Antihypertensive drugs interact with ARV drugs
备注:Amlodipine:氨氯地平;Diltiazem:地尔硫卓;Felodipine:非洛地平;Nicardipine:尼卡地平;Nifedipine:硝苯地平;Nisoldipine:尼索地平;Nitrendipine:尼群地平;Verapamil:维拉帕米
9. Anticonvulsant drugs interact with ARV drugs
备注:Diazepam：地西泮；Gabapentin：加巴喷丁；Phenobarbital：苯巴比妥
10. Antiarrhythmic drugs interact with ARV drugs
备注:Amiodarone:胺碘酮;Beprodil:苄普地尔;Disopyramide:丙吡胺;Dofetilide:多菲菜德;Lidocaine:利多卡因;Mexiletine:美西律;Propafenone:丙胺苯丙酮;Quinidine:奎尼丁
11. Antipsychotic interactions with ARV medications
备注:Amisulpride:氨磺必利;Aripiprazole:阿立哌唑;Asenapine:阿塞那平;Fluphenazine:氟非那嗪;Perazine:哌嗪;Pimozide:哌迷清;Sulpiride:舒必林
12. Antidepressant interactions with ARV medications
备注:Bupropion:安非他酮;Doxepin:多塞平;Sertraline:舍曲林
With the increasing incidence of non-HIV-defining diseases, combination therapy is inevitable, and the importance of drug interactions in the long-term management of HIV patients should be fully recognized, in addition to initiating ART therapy as early as possible to avoid infection.
Bibliography:
[1] Chinese Center for Disease Control and Prevention, Center for STD and AIDS Prevention and Control, National Handbook of Free Antiretroviral Drug Treatment for HIV (Fourth Edition). Beijing People's Medical Publishing House, 2016
[2] EACS Guidelines version 10.0, November 2019
[3] EACS Guidelines version 9.0, October 2017
The following is a recommended drug interaction applet, which is easy to use~
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