Module Abstract

Considering Drug-Drug Interactions When Selecting a First-line Antiretroviral Therapy for a Patient With a Complex Medical History

Abstract

In this clinical vignette, Charles W. Flexner, MD, and Paul Pham, PharmD, BCPS, discuss drug-drug interaction considerations and class-sparing strategies for choosing an initial antiretroviral regimen for a 62-year-old HIV-infected black male with no AIDS-related symptoms, but who has had a recent myocardial infarction (MI). Laboratory analysis indicated that his plasma HIV-1 RNA was 58,000 copies/mL and his CD4+ cell count was 290 cells/mm³. A pretreatment genotypic analysis failed to detect any resistance mutations. The patient has a past medical history of injection drug use, chronic renal insufficiency (mean serum creatinine: 2.4 mg/dL), chronic hepatitis C, anemia, and hypertension. His current medications include aspirin 81 mg once daily, atorvastatin 80 mg once daily, hydralazine/isosorbide dinitrate 75/40 mg 3 times daily, metoprolol 100 mg twice daily, and amlodipine 10 mg once daily. Drs. Flexner and Pham describe important potential drug-drug interactions to consider when combining a first-line antiretroviral regimen for a difficult-to-treat patient.