Anti-malarial Drugs & ARVs

Legend
↑     Potential elevated exposure of the anti-malarial drug
↓     Potential decreased exposure of the anti-malarial drug
↔   No significant effect
D     Potential decreased exposure of ARV drug
E     Potential elevated exposure of ARV drug

Numbers refer to increased or decreased AUC as observed in drug-drug interaction studies

ATV/c:
ATV co-formulated with COBI (300/150 mg qd)

DRV/c:
DRV co-formulated with COBI (800/150 mg qd)

CAB/RPV:
CAB and RPV im long acting injections

Interactions with ABC, FTC, 3TC, ZDV
ABC: 
No clinically relevant interactions expected

FTC:
Increased FTC exposure with pyrimethamine, sulfadoxine

3TC:
Increased 3TC exposure with pyrimethamine, sulfadoxine

ZDV:
Potential additive haematological toxicity with amodiaquine, atovaquone, primaquine, pyrimethamine, sulfadoxine

Interactions with cabotegravir (oral)
None

Interactions with ibalizumab
None

Comments

1. Liver toxicity.
2. Take with high fat meal, consider dose increase.
3. ECG monitoring is recommended.
4. Chloroquine concentrations may increase, but to a moderate extent. No dose adjustment is required but monitor toxicity.
5. Chloroquine/hydroxychloroquine concentrations may increase or decrease. No dose adjustment is required but monitor toxicity and efficacy.
6. Chloroquine concentrations may decrease, but to a moderate extent. No dose adjustment is required but monitor efficacy.
7. Caution as both drugs can induce QT interval prolongation.
8. Increase of haemotoxic metabolites. 

♥ EFV prolonged the QT interval above the regulatory threshold of concern in homozygous carriers of the CYP2B6*6/*6 allele (516T variant). Coadministration with a drug with a known risk of TdP is contraindicated in the EFV European label.

^ LEN causes moderate inhibition of CYP3A4 and, when discontinued, remains in the circulation for prolonged periods. Residual concentrations of LEN may affect the exposure of sensitive CYP3A4 substrates and/or narrow therapeutic index drugs that are initiated within 9 months after the last subcutaneous dose of LEN.

Further Information
For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to: http://www.hiv-druginteractions.org (University of Liverpool)