Interactions between highly active antiretroviral therapy and over-the-counter agents: a cautionary note

BMJ Case Rep. 2021 Jan 6;14(1):e236655. doi: 10.1136/bcr-2020-236655.


Highly active antiretroviral therapy (HAART) has dramatically lowered rates of mother-to-child HIV transmission among patients with access to treatment. Barriers to complete viral suppression increase rates of transmission, even with only low levels of viral replication. Here, we present the case of a pregnant patient who developed a detectable viral load in pregnancy, thought to be related to calcium supplement consumption or emesis while using a dolutegravir-based HAART regimen. Ultimately, with adjustments, the patient again reached an undetectable viral load and had an uncomplicated perinatal and neonatal outcome. We discuss new data on the use of dolutegravir in pregnancy and precautions for maintaining viral suppression while on antiretroviral therapy in pregnancy.

Keywords: HIV / AIDS; pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-HIV Agents / pharmacology*
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods*
  • CD4 Lymphocyte Count
  • Calcium Carbonate / pharmacology
  • Drug Interactions
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Infections / transmission
  • HIV Infections / virology
  • HIV-1 / isolation & purification
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control
  • Nonprescription Drugs / pharmacology*
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Pregnancy Complications, Infectious / virology
  • Viral Load / drug effects
  • Vitamins / pharmacology
  • Vomiting / chemically induced


  • Anti-HIV Agents
  • Nonprescription Drugs
  • Vitamins
  • Calcium Carbonate