Common Drug-drug interactions with ARVs

• Before prescribing any concomitant medication in a patient on ART, the physician needs to keep possible drug interactions at the back of mind. Checking for the same can be done at the website:www.hiv-druginteractions.com.
• Drug schedules and relationship with food intake should also be strictly followed since this helps in maintaining optimum Drug levels. For example, ddI should always be administered on an empty stomach and nelfinavir should be taken with food. In addition, a difference of more than 1-2 hours around the dosing time should be avoided as much as possible.

ARV ADVERSE EVENTS

ARV Drugs may be associated with acute and long-term adverse events (AEs). Recognizing and managing these are essential because they may compromise adherence or sometimes necessitate switching of Drugs, which may result in exhausting treatment options. Additionally, many of the concomitant Drugs used for treating OIs are also associated with overlapping toxicities, making it difficult to identify the true offending agent. Patients should also be educated about these so that they are recognized early since many long term AEs may not reverse or may take years to improve. The etiology of long term NRTI AEs involves cellular mitochondria. By inhibiting mitochondrial DNA polymerase enzyme gamma, NRTIs can induce reduction in respiratory chain function. Most of the long term AEs like lactic acidemia, pancreatitis, peripheral neuropathy, lipoatrophy, and hepatitis may be caused in this way.