Page 129 - HIV/AIDS Guidelines
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Table 11 provides the currently available pharmacokinetic (PK) interaction data that clinicians can use as a
guide for managing patients receiving ART and methadone or buprenorphine. Particular attention is needed
concerning communication between HIV care providers and drug treatment programs regarding additive
drug toxicities and drug interactions resulting in opiate withdrawal or excess.
Methylenedioxymethamphetamine (MDMA), GHB, ketamine, and methamphetamine all have the potential
to interact with ARV agents because all are metabolized, at least in part, by the CYP450 system. Overdoses
secondary to interactions between the party drugs (i.e., MDMA or GHB) and PI-based ART have been
reported. 16
Summary
It is usually possible over time to support most active drug users such that acceptable adherence levels with
ARV agents can be achieved. 17-18 Providers must work to combine all available resources to stabilize an
active drug user in preparation for ART. This should include identification of concurrent medical and
psychiatric illnesses, drug treatment and needle and syringe exchange programs, strategies to reduce high-
risk sexual behavior, and harm-reduction strategies. A history of drug use alone is insufficient reason to
withhold ART because individuals with a history of prior drug use have adherence rates similar to those who
do not abuse drugs.
Important considerations in the selection of successful regimens and the provision of appropriate patient
monitoring in this population include need for supportive clinical sites; linkage to substance abuse treatment;
and awareness of the interactions between illicit drugs and ARV agents, including the increased risk of side
effects and toxicities. Simple regimens should be considered to enhance medication adherence. Preference
should be given to ARV agents that have a lower risk of hepatic and neuropsychiatric side effects, simple
dosing schedules, and minimal interaction with methadone.
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents I-13
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