HIV TREATMENT

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People living with HIV, and those using pre-exposure prophylaxis (PrEP) for HIV prevention, should know that nearly all HIV medications can interact with other drugs, certain foods, and supplements.[1–4] It is important to know when these drug interactions can occur, how to try and prevent them from happening, and how best to manage them.

WHAT ARE DRUG INTERACTIONS?

A drug interaction is a reaction between two or more drugs that can affect how the drugs work and/or cause side effects.[1] Drug interactions with antiretroviral (ARV) medications can be dangerous and may lead to severe health issues.[3,5,6]

When ARVs interact with other drugs, they can affect three important processes in the body:[3,7]

  • Absorption: This is how much of either medication gets into the bloodstream.
  • Metabolism: This is how quickly the body breaks down the medications, often involving CYP450 enzymes.
  • Excretion: This is how fast the body removes the medications.

Changes in any of these processes can lead to either too much or too little of the ARV or other medication in your system.[3,7] A decrease in drug levels can reduce their effectiveness. If ARV levels are too low, this can also lead to HIV drug resistance.[3] HIV drug resistance is where changes in the structure of the HIV virus make medications less effective in treating it, leading to the HIV virus becoming resistant to the drug's effects.[8] Alternatively, an increase in drug levels can create toxic combinations or cause harmful side effects.[3,7]

It’s important to read the patient information leaflet (PIL) that comes with medications, keep an eye out for any changes in your health, and discuss any side effects with a healthcare provider.[9] They can help determine if any symptoms are due to drug interactions or routine antiretroviral therapy (ART).

TYPES OF HIV DRUGS

The four most commonly prescribed classes of ARV drugs are:[10]

  • Protease inhibitors (PIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Integrase strand transfer inhibitors (INSTIs)

They can all interact with drugs in various ways. Certain ARV drug classes (PIs, INSTIs, and NNRTIs) may be more likely to interact with other drugs because they are broken down by the same CYP450 enzymes that are responsible for breaking down many other medications in the body.[7,11] NRTIs are not broken down by CYP450 enzymes, which means that they are the least likely drug class to interact with other drugs.[12]

COMMON HIV DRUG-DRUG INTERACTIONS

There are certain groups of medications that, when used alongside ART, can sometimes interact with ARVs.[3,4,13–16]

  • Cardiovascular and blood pressure medications

    People living with HIV who take beta-blockers for high blood pressure may have a higher risk of heart problems compared to those using other medications.[15] This risk remains even when blood pressure is well-controlled, which suggests that beta-blockers may interact with HIV medications.[15,17]

    Some calcium channel blockers and blood thinners, such as warfarin, can also cause drug interactions because they are broken down by an enzyme from the CYP450 family.[15] This can change how the medications work in your body.

  • Hormonal contraceptives

    Most ARVs have limited interactions with hormonal contraceptives, and hormonal contraceptives do not reduce the effectiveness of ARV drugs.[13]

    However, certain ARVs can potentially reduce the effectiveness of hormonal contraceptives, increasing the risk of unintended pregnancy.[13,14] Types of contraception that may have potential interactions with these HIV medications include:[13]

    Combined pills

    Patches

    Progesterone-only pills

    Hormonal implants

    Vaginal rings

    Emergency contraception

    Other types of hormonal contraceptives, such as levonorgestrel-releasing IUDs, depot medroxyprogesterone acetate (DMPA) progestogen-only injectables, and non-hormonal options like copper IUDs are considered to be unaffected.[13]

    Women living with HIV who use contraception should always check the possibilities of drug interactions with their healthcare professional.

  • Natural/herbal remedies and foods

    People living with HIV may use dietary supplements or herbal medicine. However, certain foods, supplements and herbal remedies should not be taken with ART, as they can reduce the effectiveness of some ARV drugs.[16] For instance, herbal supplements like St. John’s wort, certain types of garlic, grapefruit, and red rice yeast can significantly interact with some ARVs.[16] As a result, they should either be avoided or used with caution with certain ARVs.[16]

    It is essential to speak with your healthcare provider about your diet and any herbal/natural supplements you are taking. They can provide guidance on if and how these may affect your ART.

  • Steroids

    Steroid-based medications, including inhalers and nasal sprays, can interact with ARV drugs.[3,7] When combined with ARVs, these interactions can lead to severe conditions such as life-threatening adrenal insufficiency, where the body doesn’t produce enough hormones, or Cushing’s syndrome, a condition caused by an excess of cortisol. [3,7,18]

    Some of these steroid-based medications are commonly available over-the-counter, so it is important to inform the prescriber of your ART regimen to avoid these harmful effects.[3]

  • Non-steroidal anti-inflammatory drugs (NSAIDs)

    Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, are commonly used to relieve pain and reduce inflammation.[4] However, taking these drugs regularly alongside certain types of PrEP may lead to kidney problems.[4]

    If you are taking PrEP, it’s important to avoid frequent use of NSAIDs.[4] Inform your doctor if you need to use these medications regularly, as they may recommend safer alternatives.

AGEING AND HIV DRUG INTERACTIONS

As people living with HIV age, they are at increased risk of experiencing HIV drug-drug interactions. This is especially true in people living with HIV aged 50 years and above.[19,20] As people age, conditions such as cardiovascular disease (CVD) become more common, which increases the likelihood of polypharmacy — the regular use of multiple medications.[19,20] This in turn increases the chances of drug-drug interactions.[19,20]

Ageing with HIV can have its own specific challenges. ViiV Healthcare runs and supports multiple studies to build our understanding of how treatments affect older people living with HIV. One of our focuses is reducing the short and long-term burden of ART on people's lives, which considers potential drug interactions from polypharmacy.

AWARENESS OF HIV DRUG-DRUG INTERACTIONS

It is important to communicate openly and honestly with your doctor about your diet, as well as any prescription or over-the-counter medications, recreational drugs, or supplements you are using or planning to use.

Make sure that you take all your medication according to your healthcare provider’s instructions, reading drug labels and package inserts thoroughly. These contain the relevant information about potential drug interactions, along with what to do in the case of a drug interaction.

A medication review is especially beneficial for older adults, those on multiple medications, or individuals who have been on ART long-term.[21,22] Maintaining a complete medication list helps reduce the risk of drug-drug interactions, while specialist pharmacist consultations before HIV outpatient visits improve their detection.[21]

It’s important to always read the patient leaflet of any medicines that you are taking, but there are also some useful resources online. The University of Liverpool has a helpful HIV drug interaction checker tool, which allows you to check for interactions between your HIV medications and other drugs.[23] If the results of any medications are concerning, it is important to discuss it with your doctor.

Abbreviations:

ART, antiretroviral therapy; ARV, antiretroviral; CVD, cardiovascular disease; DMPA, depot medroxyprogesterone acetate; INSTI, integrase strand transfer inhibitor; IUD, intrauterine device; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; PIL, patient information leaflet; PrEP, pre-exposure prophylaxis.

References:

  1. AIDSMAP. Wilberg M. HIV treatment and drug-drug interactions. Available from: https://www.aidsmap.com/about-hiv/hiv-treatment-and-drug-drug-interactions [Accessed: March 2025]
  2. Jalloh MA, Gregory PJ, Hein D, Risoldi Cochrane Z, Rodriguez A. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017];28(1):4–15. doi: 10.1177/0956462416671087
  3. de Oliveira Costa J, Lau S, Medland N, Gibbons S, Schaffer AL, Pearson SA. Potential drug-drug interactions due to concomitant medicine use among people living with HIV on antiretroviral therapy in Australia. Br J Clin Pharmacol 2023;89(5):1541–53. doi: 10.1111/bcp.15614
  4. i-Base. UK guide to PrEP: 10th edition. 2024. Available from: https://i-base.info/guides/wp-content/uploads/2024/02/PrEP-guide-UK-Feb-2024-FIN.pdf [Accessed: March 2025]
  5. Clinical Guidelines Program. Resource: ART Drug-Drug Interactions. 2024. Available from: https://www.hivguidelines.org/guideline/hiv-art-drug-interactions/ [Accessed: March 2025]
  6. AIDSMAP. Nuh O. Interactions between HIV treatment and recreational drugs. 2020. Available from: https://www.aidsmap.com/about-hiv/interactions-between-hiv-treatment-and-recreational-drugs [Accessed: March 2025]
  7. National HIV Curriculum. Drug Interactions with Antiretroviral Medications - Antiretroviral Therapy. 2025. Available from: https://www.hiv.uw.edu/go/antiretroviral-therapy/drug-drug-interactions/core-concept/all [Accessed: March 2025]
  8. WHO. HIV drug resistance. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/hiv-drug-resistance [Accessed: March 2025]
  9. GOV.UK. Best practice guidance on patient information leaflets. 2014. Available from: https://www.gov.uk/government/publications/best-practice-guidance-on-patient-information-leaflets [Accessed: March 2025]
  10. NIH. Kemnic TR, Gulick PG. HIV antiretroviral therapy. 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/ [Accessed: March 2025]
  11. Amariles P, Rivera-Cadavid M, Ceballos M. Clinical relevance of drug interactions in people living with human immunodeficiency virus on antiretroviral therapy-update 2022: Systematic review. Pharmaceutics. 2023;15(10):2488. doi: 10.3390/pharmaceutics15102488
  12. Berretta M, Caraglia M, Martellotta F, Zappavigna S, Lombardi A, Fierro C, et al. Drug-drug interactions based on pharmacogenetic profile between Highly Active Antiretroviral Therapy and antiblastic chemotherapy in cancer patients with HIV infection. Front Pharmacol. 2016 Mar 30:7:71 doi: 10.3389/fphar.2016.00071
  13. FSRH. Clinical Guidance: Drug Interactions Between HIV Antiretroviral Therapy (ART) and Contraception. 2023. Available from: https://www.fsrh.org/Common/Uploaded%20files/documents/hiv-drug-interactions-with-contraception-07feb2023.pdf [Accessed: March 2025]
  14. Krishna GR, Haddad LB. Interactions between hormonal contraception and anti-Retroviral therapy: An updated review. Curr Obstet Gynecol Rep. 2020 Sep;9(3):98-104. doi: 10.1007/s13669-020-00289-7
  15. Foy M, Sperati CJ, Lucas GM, Estrella MM. Drug interactions and antiretroviral drug monitoring. Curr HIV/AIDS Rep. 2014 Sep;11(3):212–22. doi: 10.1007/s11904-014-0212-1
  16. Bordes C, Leguelinel-Blache G, Lavigne JP, Mauboussin JM, Laureillard D, Faure H, et al. Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review. Clin Microbiol Infect. 2020 Sep;26(9):1161–70. doi: 10.1016/j.cmi.2020.04.019
  17. American Heart Association. Certain high blood pressure medications may alter heart risk in people with HIV. 2021. Available from: https://newsroom.heart.org/news/certain-high-blood-pressure-medications-may-alter-heart-risk-in-people-with-hiv [Accessed: March 2025]
  18. Raff H, Sharma ST, Nieman LK. Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing’s syndrome, adrenal insufficiency, and congenital adrenal hyperplasia. Compr Physiol. 2014 Apr;4(2):739–69. doi: https://doi.org/10.1002/cphy.c130035
  19. Marzolini C, Back D, et al. Ageing with HIV: medication use and risk for potential drug-drug interactions. J Antimicrob Chemother 2011 Sep;66(9):2107–11. doi: 10.1093/jac/dkr248
  20. Ranzani A, Oreni L, et al. Burden of exposure to potential interactions between antiretroviral and non-antiretroviral medications in a population of HIV-positive patients aged 50 years or older. J Acquir Immune Defic Syndr. 2018 Jun;78(2):193–201. doi: 10.1097/QAI.0000000000001653
  21. Leake Date HA, Alford K, et al. Structured medicines reviews in HIV outpatients: a feasibility study (The MOR Study). HIV Med. 2022 Jan;23(1):39–47. doi: https://doi.org/10.1111/hiv.13158
  22. HealthinAging.org. Medications Work Differently in Older Adults. 2023. Available from: https://www.healthinaging.org/medications-older-adults/medications-work-differently-older-adults [Accessed: March 2025]
  23. University of Liverpool. HIV drug interactions checker. 2025. Available from: https://www.hiv-druginteractions.org/checker [Accessed: March 2025]

NP-GBL-HVX-COCO-250018 July 2025

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the GSK Reporting Tool link https://gsk.public.reportum.com/. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ ViiV by selecting your region and market, here.