Módulo 1 – Curso pós-graduado – VIH e Envelhecimento

Drug-drug Interactions and Polypharmacy in Older HIV Persons

Drug interactions and management of HIV infection

Autor: David Burger, PharmD PhD (Radboud University Nijmegen, Holanda)

Table II. Summary of drug interactions mechanisms with antiretroviral drugs (adapted from Burger, 2015 – personal communication)

tudo sobre o hiv, sintomas do hiv e prevenção - vihda
tudo sobre o hiv, sintomas do hiv e prevenção - vihda

Table II shows the most common antiretroviral treatment for HIV and at higher risk of interactions. Table IIa displays enzymes or transporters that use antiretroviral drugs as a substrate (“victim”). Interactions can also occur on the absorption, particularly by changing pH or complexation / chelation. Table IIb shows the mechanisms for which antiretrovirals are promoters (“perpetrator”) of interactions, due to inhibition or induction of enzymes or transporters.

As presented in the table, ritonavir has a high risk of drug inte- ractions because it is a substrate for some enzymes (CYP3A, CYP2D6) and transporters [PgP, multidrug resistanceassociated protein (MRhttps://vihda.psales.pt/wp-admin/post.php?post=3367&action=edit#saveP-1)] but also because it acts on other several enzymes (inhibits: CYP3A CYP2D6; induces CYP1A2, CYP2C8, CYP2C9, CYP2C19, UGT1A1) and transporters [inhibit P-gP, organic aniontransporting polypeptide (OATP), MRP-1, breast cancer resistance protein (BCRP)]. Similarly, the potential for interactions with cobicistat is also high. Moreover, RAL, RPV and DTG appear to have less potential for interactions.

In addition to this table, there are other tools to support the identification of drug interactions in the treatment of HIV infection, as the website of the University of Liverpool (http:// www.hiv-druginteractions.org/).

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