Pharmacokinetic Outcomes of the Interactions of Antiretroviral Agents with Food and Supplements: A Systematic Review and Meta-Analysis

Abstract

Because pharmacokinetic changes in antiretroviral drugs (ARV), due to their concurrent administration with food or nutritional products, have become a clinical challenge, it is necessary to monitor the therapeutic efficacy of ARV in people living with the human immunodeficiency virus (PLWH). A systematic review and meta-analysis were conducted to clarify the pharmacokinetic outcomes of the interaction between supplements such as food, dietary supplements, and nutrients, and ARV. Twenty-four articles in both healthy subjects and PLWH were included in the qualitative analysis, of which five studies were included in the meta-analysis. Food–drug coadministration significantly increased the time to reach maximum concentration (tmax) (p < 0.00001) of ARV including abacavir, amprenavir, darunavir, emtricitabine, lamivudine, zidovudine, ritonavir, and tenofovir alafenamide. In addition, the increased maximum plasma concentration (Cmax) of ARV, such as darunavir, under fed conditions was observed. Area under the curve and terminal half-life were not significantly affected. Evaluating the pharmacokinetic aspects, it is vital to clinically investigate ARV and particular supplement interaction in PLWH. Educating patients about any potential interactions would be one of the effective recommendations during this HIV epidemic.

Interactions of Antiretroviral Drugs with Food, Beverages, Dietary Supplements, and Alcohol: A Systematic Review and Meta-analyses

“…Since then, many new antiretroviral drugs have been registered and novel formulations of already registered drugs have been developed. The second systematic review, by Siritientong et al, is up-to-date, however, in this review, very general keywords were used, making the number of included studies relatively small [ 17 ]. In addition, the effect of food was investigated either for all antiretroviral drugs simultaneously or within pharmacological groups, and not for individual drugs.…”

The effect of consumption of Mangifera indica (Linn) fruit on the plasma concentration profile of zidovudine, lamivudine and nevirapine

“…Taking Zidovudine with a meal, particularly a high-fat meal, can reduce absorption.For optimum absorption, Zidovudine is recommended to be taken on an empty stomach. Nevirapine, unlike Zidovudine, can be taken with or without food because food does not affect its absorption [22].…”

Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy—Update 2022: Systematic Review

“…Food (standard breakfast and protein-rich drink) [193][194][195] EVG/COBI/FTC/TAF EVG/COBI/FTC/TAF administration under fasted conditions is associated with a decrease by 50% and 57% in the mean AUC and C max of EVG, respectively. Thus, EVG/COBI/FTC/TAF should be administered orally once daily with food, for instance, a standard breakfast (413 kcal, 10% fat: two slices of bread with strawberry jam, one boiled egg, and 160 g of grape juice).…”