Anti-infective Drugs for OIs and STIs and ARVs

Legend
↑     Potential elevated exposure of the anti-infective
↓     Potential decreased exposure of the anti-infective
↔   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

Antibacterial
- Refer to the Anti-tuberculosis table for interactions with amikacin, moxifloxacin and rifabutin ;
- Refer to the Anti-malarial table for interactions with clindamycin and doxycycline.

Antiparasitic
Refer to the Anti-malarial table for interactions with atovaquone, primaquine and pyrimethamine.

Interactions with cabotegravir (oral)
None

Interactions with ibalizumab
None

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

FTC:
- Potential additive renal toxicity with sulfadiazine and flucytosine; 
- Potential increased FTC exposure with trimethoprim, but no dose adjustment required in patients with
normal renal function; 
- Potential additive renal toxicity with sulfadiazine and flucytosine; 
- Increased 3TC exposure (43%) with trimethoprim, but no dose adjustment required in patients with normal renal function. Some trimethoprim/sulfamethoxazole liquid preparations may contain sorbitol which decreases the bioavailability of lamivudine solutions

ZDV:
- Potential risk of additive haematoxicity with brincidofovir and flucytosine;
- Increased ZDV exposure (20%) with ganciclovir;
- Decreased ZDV exposure (12%) with clarithromycin; 
- Potential increased risk of ZDV adverse reactions with trimethoprim, sulfamethoxazole, amphotericin B and flucytosine; 
- Increased ZDV exposure (74%) with fluconazole. Routine ZDV dose modification not required, but monitor for potential ZDV toxicity; 
- No PK interaction observed with dapsone but potential increased risk of ZDV adverse reactions; 
- Potential increased risk of ZDV adverse reactions with pentamidine (but not with aerosolised pentamidine at doses used in prophylaxis)

Comments

1. TDF should be avoided with concurrent or recent use of a nephrotoxic agent. If co-administration is unavoidable, monitor renal function closely.
2. ECG monitoring is recommended.
3. Caution as both drugs can induce QT interval prolongation.
4. Co-administration could potentially increase haematological toxicity. Monitor haematological parameters and consider dose reduction if required.
5. Renal impairment and sometimes fatal renal failure have been described with meglumine antimoniate treatment. Close monitoring of renal function is warranted.

♥ 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.

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)