title: Drug-drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems.
abstract: BACKGROUND
  Substance abuse is a common problem among HIV-infected individuals. Importantly, addictions as well as moderate use of alcohol, smoking, or other illicit drugs have been identified as major reasons for non-adherence to antiretroviral therapy (ART) among HIV patients. The literature also suggests a decrease in the response to ART among HIV patients who use these substances, leading to failure to achieve optimal virological response and increased disease progression.
  
  
  METHODS
  This review discusses the challenges with adherence to ART as well as observed drug interactions and known toxicities with major drugs of abuse, such as alcohol, smoking, methamphetamine, cocaine, marijuana, and opioids. The lack of adherence and drug interactions potentially lead to decreased efficacy of ART drugs and increased ART, and drugs of abuse-mediated toxicity. As CYP is the common pathway in metabolizing both ART and drugs of abuse, we discuss the possible involvement of CYP pathways in such drug interactions.
  
  
  CONCLUSIONS
  We acknowledge that further studies focusing on common metabolic pathways involving CYP and advance research in this area would help to potentially develop novel/alternate interventions and drug dose/regimen adjustments to improve medication outcomes in HIV patients who consume drugs of abuse.
authors.affiliation: University of Tennessee Health Science Center, College of Pharmacy, Department of Pharmaceutical Sciences , 881 Madison Ave., Memphis, TN 38163 , USA ksantosh@uthsc.edu.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.forename: P S S
authors.initials: PS
authors.lastname: Rao
authors.forename: Ravindra
authors.initials: R
authors.lastname: Earla
authors.forename: Anil
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000818:Animals; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D018450:Disease Progression; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000493:pharmacokinetics; D055118:Medication Adherence; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D013287:Illicit Drugs; D003577:Cytochrome P-450 Enzyme System
keywords: CYP; HIV; antiretroviral therapy; drug interactions; drugs of abuse