Drug-drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems

Expert Opin Drug Metab Toxicol. 2015 Mar;11(3):343-55. doi: 10.1517/17425255.2015.996546. Epub 2014 Dec 24.


Introduction: 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.

Areas covered: 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.

Expert opinion: 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.

Keywords: CYP; HIV; antiretroviral therapy; drug interactions; drugs of abuse.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / pharmacokinetics
  • Anti-HIV Agents / therapeutic use*
  • Cytochrome P-450 Enzyme System / metabolism
  • Disease Progression
  • Drug Interactions
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • Humans
  • Illicit Drugs / adverse effects
  • Illicit Drugs / pharmacokinetics
  • Medication Adherence
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / epidemiology
  • Treatment Outcome


  • Anti-HIV Agents
  • Illicit Drugs
  • Cytochrome P-450 Enzyme System