Polypharmacy and organ dysfunction are common problems in patients on ICU. Antiretroviral drugs, especially the NNRTIs and boosted PIs, have several important drug–drug interactions. The main interactions are mediated via either inhibition or induction of the cytochrome p450 enzyme pathway. Newer antiretroviral agents and alternative treatment strategies can provide options of continuing therapy without dose modification or cessation of cART.

Examples of drug–drug interactions with antiretrovirals and drugs commonly used in HIV-seropositive persons in ICU include:

  • Antibiotics e.g. rifampicin, rifabutin and clarithromycin
  • Antifungals e.g. azoles, amphotericin and caspofungin
  • Acid lowering agents e.g. H2 antagonists and proton pump inhibitors
  • Anticonvulsants e.g. carbamazepine, phenytoin
  • Anticaogulants e.g. warfarin
  • Anti-arrythmics
  • Benzodiazepines
  • Statins