An update on drug–drug interactions between antiretroviral therapies and drugs of abuse in HIV systems

ABSTRACT

Introduction

While considerable progress has been made in the fight against HIV/AIDS, to date there has not been a cure, and millions of people around the world are currently living with HIV/AIDS. People living with HIV/AIDS have substance abuse disorders at higher rates than non-infected individuals, which puts them at an increased risk of drug–drug interactions.

Areas covered

Potential drug–drug interactions are reviewed for a variety of potential drugs of abuse, both licit and illicit. These drugs include alcohol, cigarettes or other nicotine delivery systems, methamphetamine, cocaine, opioids, and marijuana. Potential interactions include decreased adherence, modulation of drug transporters, or modulation of metabolic enzymes. We also review the relative incidence of the use of these drugs of abuse in People living with HIV/AIDS.

Expert opinion

Despite considerable improvements in outcomes, disparities in outcomes between PLWHA who use drugs of abuse, vs those who do not still exist. It is of critical necessity to improve outcomes in these patients and to work with them to stop abusing drugs of abuse.

KEYWORDS:

• Antiretrovirals
• drug transporters
• drugs of abuse
• HIV-1
• metabolic enzymes

Article highlights

• People living with HIV/AIDS are more likely to use substances of abuse than non-infected individuals.

• PLWHA with substance use disorders have worsened outcomes compared to PLWHA who do not use drugs of abuse.

• The reasons for this are multifactorial and include decreased adherence, modulation of drug efflux transporters, and modulation of metabolic enzymes.

• Modulations of efflux transporters and metabolic enzymes can result in altered concentrations and efficacy of antiretrovirals for the treatment of HIV-1.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the National Institute of Health (Grant number: NIH R01AA022063).