HIV and other illnesses
SOME DOS AND DONTS FOR POSITIVE PATIENTS ON MEDS Patients very often receive therapy for a host of other conditions.
Most of the time people with HIV tend to have other conditions too, chronic or acute. Or some just take over-thecounter medications, even herbal or traditional medicines.
I find literature not so available for patients to know what the risks are. Most of the literature that is out there is meant for clinicians.
Let us start by saying it is very important that as an HIV positive patient on antiretrovirals, when you visit your clinician you must give a thorough medication history that includes prescription medications, including those prescribed by other providers, over-the-counter medications, recreational drugs and herbal/alternative therapies.
This will allow the clinician to accurately predict drugs that may lead to significant interactions. The clinician will also then be able to identify dietary restrictions with ARV drugs.
Current treatment guidelines recommend the use of a combination of at least three ARV drugs for the treatment of HIV-infected patients.
In addition to medications to treat HIV infection, patients often receive therapy for other conditions and prevention of opportunistic infections.
Because of the number of drugs that the HIV-infected patient receives, clinicians must often rely on clinical judgment and are forced to predict drug interactions without supporting data.
Drug interactions are classified as pharmacokinetic or pharmacodynamics.
Pharmacokinetic means the interaction leads to a change in the absorption, distribution, metabolism or excretion of the drug. This can lead to increased available dosages of the drug leading to toxicity or decrease leading to poor effect of the drug, or just changed activity of the drug.
Pharmacodynamic means the interaction leads to additive, synergistic or antagonistic effects. This can cause increased or decreased effect of the drug.
Find out which class of ARVs you are taking from your doctor as this has an effect on how they act when they come in contact with other drugs. Commonest are NNRTIs and PIs. It is very important that the doctor monitors your anticonvulsant levels if you are taking concurrent ARV and anticonvulsant therapy.
The doctor should avoid prescribing carbamazepine, phenobarbital and phenytoin for patients if you are taking NNRTIs or PIs. Other newer epilepsy drugs can be considered.
Because of the capacity of phenytoin, phenobarbital, and carbamazepine to induce metabolic enzymes, these drugs should be avoided in patients receiving NNRTIs or PIs.
They have the potential to significantly reduce HIV serum con-