JAK-STAT Signaling Pathway noted that the investigational integrase inhibitor elvitegravir

substance use, oncology diagnoses, or solid organ transplantation. Finally, patients may also be taking vitamins, food supplements, complementary/alternative Chrysin medicine , or recreational agents on a regular or occasional basis. Therefore, there is a high potential for drug interactions in this population, se protease inhibitors and non nucleoside reverse transcriptase inhibitors are both substrates and inhibitors or inducers of CYP450 hepatic enzymes and drug transporters. Clinically significant drug interactions have been reported in 27%–40% of HIV patients on cART, with PI use, number of concomitant medications, current illicit drug use and hepatitis C coinfection identified as independent risk factors . The integrase inhibitor raltegravir is not involved in the CYP450 system, and may be a suitable option to use when trying to minimize interactions with other drug classes.
In contrast, it should be noted that the investigational integrase inhibitor, elvitegravir, which is in late stage development, is a CYP3A4 substrate and requires boosting with an inhibitor to achieve therapeutic concentrations. Negative consequences of drug interactions lude viral breakthrough and development of resistance, sub optimal disease/symptom management, or drug toxicity JAK-STAT Signaling Pathway and possible non adherence . This review summarizes recently published data on clinically significant drug interactions between antiretrovirals and other drug classes luding antineoplastic agents, immunosuppressant transplant drugs, directly acting antivirals for hepatitis C infection, oral antifungals, anti malarial agents, corticosteroids, psychotropic drugs, hormonal contraceptives, anticoagulants, drugs for pulmonary hypertension, and herbal products.
Antineoplastic Agents Avoiding and managing potential interactions between ARVs and antineoplastic agents is an reasingly important challenge. Patients who receive concomitant cancer chemotherapy and cART may achieve better response rates and higher rates of survival than patients who receive antineoplastic therapy alone, but may be at reased cryostat risk of pharmacokinetic or pharmacodynamic drug interactions. Such drug interactions may be associated with reased toxicity and/or decreased efficacy of treatment regimens for either disease state, possibly leading to clinically detrimental or devastating consequences. Readers are referred to comprehensive reviews on this topic .
Recent case reports and study findings highlight the nature and significance of interactions between antineoplastics and antiretroviral therapy. New data on vinblastine, docetaxel, paclitaxel, bexarotene, and CHOP in the context of concomitant cART use will be reviewed. In a retrospective review of 16 HIV positive patients on cART who received vinblastine based regimens for Hodgkin’s lymphoma, PI use was independently associated with WHO grade III–IV neutropenia after controlling for CD4 counts less than 200 cells/mm3, zidovudine use and bone marrow involvement. An inverse correlation between ritonavir dose and mean nadir neutrophil count was found . Another report noted the development of severe vinblastine associated neurotoxicity in 3 patients during treatment with ABVD for Hodgkin’s lymphoma while on concomitant lopinavir/ritonavir based cART.

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