title: Clinically relevant drug-drug interactions between antiretrovirals and antifungals.
abstract: BACKGROUND
  Complete delineation of the HIV-1 life cycle has resulted in the development of several antiretroviral drugs. Twenty-five therapeutic agents belonging to five different classes are currently available for the treatment of HIV-1 infections. Advent of triple combination antiretroviral therapy has significantly lowered the mortality rate in HIV patients. However, fungal infections still represent major opportunistic diseases in immunocompromised patients worldwide.
  
  
  METHODS
  Antiretroviral drugs that target enzymes and/or proteins indispensable for viral replication are discussed in this article. Fungal infections, causative organisms, epidemiology and preferred treatment modalities are also outlined. Finally, observed/predicted drug-drug interactions between antiretrovirals and antifungals are summarized along with clinical recommendations.
  
  
  CONCLUSIONS
  Concomitant use of amphotericin B and tenofovir must be closely monitored for renal functioning. Due to relatively weak interactive potential with the CYP450 system, fluconazole is the preferred antifungal drug. High itraconazole doses (> 200 mg/day) are not advised in patients receiving booster protease inhibitor (PI) regimen. Posaconazole is contraindicated in combination with either efavirenz or fosamprenavir. Moreover, voriconazole is contraindicated with high-dose ritonavir-boosted PI. Echinocandins may aid in overcoming the limitations of existing antifungal therapy. An increasing number of documented or predicted drug-drug interactions and therapeutic drug monitoring may aid in the management of HIV-associated opportunistic fungal infections.
authors: University of Missouri-Kansas City, School of Pharmacy, Division of Pharmaceutical Sciences , Kansas City, MO 64108 , USA.
authors: Ramya Krishna
authors: RK
authors: Vadlapatla
authors: Mitesh
authors: M
authors: Patel
authors: Durga K
authors: DK
authors: Paturi
authors: Dhananjay
authors: D
authors: Pal
authors: Ashim K
authors: AK
authors: Mitra
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000627:therapeutic use; D002219:Carbamates / Q000627:therapeutic use; D003521:Cyclopropanes; D004347:Drug Interactions; D016903:Drug Monitoring; D054714:Echinocandins / Q000627:therapeutic use; D005663:Furans; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D010755:Organophosphates / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000480:Alkynes; D044966:Anti-Retroviral Agents; D000935:Antifungal Agents; D048588:Benzoxazines; D002219:Carbamates; D003521:Cyclopropanes; D054714:Echinocandins; D005663:Furans; D017320:HIV Protease Inhibitors; D010755:Organophosphates; D011743:Pyrimidines; D013449:Sulfonamides; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; C098320:efavirenz; D065819:Voriconazole; D019438:Ritonavir; C426859:fosamprenavir