Managing Drug Interactions between Antiretrovirals and Opportunistic Infections in People with HIV

INTRODUCTION: While care for people with HIV has significantly improved, opportunistic infections remain a risk for patients. Antiretrovirals can interact with the drugs used to treat opportunistic infections, and care must be taken to minimize these interactions. METHODOLOGY: We completed a narrative review of medications to treat opportunistic infections in people with HIV and antiretrovirals. RESULTS: Here we review the risks of opportunistic infections, most notably hepatitis B, hepatitis C, tuberculosis, cryptococcal meningitis, and pneumocystis pneumonia, in people with HIV, including known and potential interactions between antiretrovirals and the treatments for opportunistic infections, and the mechanisms of these interactions. We also discuss immune reconstitution inflammatory syndrome, an inflammatory response due to immune rebound, which can occur in people treated with antiretrovirals, particularly in patients who have active opportunistic infections. DISCUSSION: While the risk of IRIS has decreased for many opportunistic infections, it can still occur, particularly in patients who are infected with Cryptococcus neoformans. Treating opportunistic infections in people with HIV requires considerable care and expertise. CONCLUSION: While advancements in care have simplified treatment for these patients, there is still a considerable risk of interactions between antiretrovirals and opportunistic infections, as well as the drugs used to treat them. Future strategies, including newer agents, regimen simplification, and comprehensive management strategies, can further decrease the risk of interactions between antiretrovirals and opportunistic infection agents, as well as further decrease the risk of IRIS.