HIV-1 Virologic Rebound Due to Coadministration of Divalent Cations and Bictegravir

A potential drug-drug interaction exists between divalent and trivalent cations (Ca 2+ , Fe 3+ , Mg 2+ , Al 3+ , Zn 2+ ) and HIV-1 integrase strand transfer inhibitors (INSTIs). There are limited case reports describing the clinical significance of this potential interaction and none to our knowledg...

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Bibliographic Details
Published in:	Infectious diseases and therapy Vol. 9; no. 3; pp. 691 - 696
Main Authors:	Rock, Alex E., DeMarais, Patricia L., Vergara-Rodriguez, Pamala T., Max, Blake E.
Format:	Journal Article
Language:	English
Published:	Cheshire Springer Healthcare 01-09-2020 Springer Springer Nature B.V Adis, Springer Healthcare
Subjects:	Acquired immune deficiency syndrome AIDS Aluminum Antacids Anti-HIV agents Antiretroviral agents Antiviral agents Atazanavir Bacterial infections Biological products industry Calcium Case Report Case reports Cations Diabetes Dietary supplements Divalent cations Drug dosages Drug interaction Drug interactions Drug therapy Fenofibrate Foot diseases Highly active antiretroviral therapy HIV HIV (Viruses) HIV integrase inhibitors Hospitals Human immunodeficiency virus Infections Infectious Diseases Internal Medicine Medicine Medicine & Public Health Divalent cations Calcium HIV HIV integrase inhibitors Integrase strand transfer inhibitors AIDS Drug interaction INSTI Zinc
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Summary:	A potential drug-drug interaction exists between divalent and trivalent cations (Ca 2+ , Fe 3+ , Mg 2+ , Al 3+ , Zn 2+ ) and HIV-1 integrase strand transfer inhibitors (INSTIs). There are limited case reports describing the clinical significance of this potential interaction and none to our knowledge identifying zinc co-administration with INSTIs. In this report we present a patient taking bictegravir/emtricitabine/tenofovir alafenamide who became viremic after ingesting zinc and calcium supplements and later was able to obtain virologic re-suppression after discontinuing supplements. This case represents a potential significant drug interaction between a commonly prescribed antiretroviral drug class and readily available over-the-counter divalent cation products.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	2193-8229 2193-6382
DOI:	10.1007/s40121-020-00307-4