Sahai J
Clinical Investigation Unit, Ottawa General Hospital, Ontario, Canada.
AIDS. 1996 Nov;10 Suppl 1:S21-5.
To review what is known from in vitro and in vivo studies about the interactions, both potentially beneficial and potentially harmful, of antiretroviral agents with each other and with other classes of drugs.
Some interactions between nucleoside HIV reverse transcriptase inhibitors and between nucleoside analogues and HIV protease inhibitors result in greater antiretroviral activity (e.g. zalcitabine with saquinavir). Others may increase the risks of toxicity and there are a number of combinations of nucleoside agents with other drugs that should be used with caution or avoided completely.
These drugs are metabolized by cytochrome P450 CYP3A4 in the liver; because they have the potential to inhibit this enzyme they may interact with many other drugs that are metabolized by this pathway. Ritonavir also inhibits other cytochrome P450 enzymes and so interacts with numerous drugs from a range of classes. Potentially beneficial interactions between protease inhibitors include the increase in saquinavir levels brought about by ritonavir.
Knowledge of additive and synergistic interactions between antiretroviral agents should facilitate development of therapeutic regimens with prolonged antiretroviral activity. Thorough investigation of possibly harmful interactions with co-administered drugs and education of clinicians and patients about the risks of these interactions is required.
综述体外和体内研究中关于抗逆转录病毒药物之间以及与其他各类药物之间潜在有益和潜在有害相互作用的已知情况。
核苷类HIV逆转录酶抑制剂之间以及核苷类似物与HIV蛋白酶抑制剂之间的某些相互作用可导致更高的抗逆转录病毒活性（例如扎西他滨与沙奎那韦）。其他相互作用可能会增加毒性风险，并且核苷类药物与其他药物的多种组合应谨慎使用或完全避免。
这些药物在肝脏中由细胞色素P450 CYP3A4代谢；由于它们有可能抑制这种酶，所以可能与通过该途径代谢的许多其他药物相互作用。利托那韦也抑制其他细胞色素P450酶，因此与多种类别的众多药物相互作用。蛋白酶抑制剂之间潜在有益的相互作用包括利托那韦使沙奎那韦水平升高。
了解抗逆转录病毒药物之间的相加和协同相互作用应有助于开发具有延长抗逆转录病毒活性的治疗方案。需要对与同时使用的药物可能存在的有害相互作用进行全面研究，并对临床医生和患者进行关于这些相互作用风险的教育。
