Cited by 102HIV/AIDS drug development and treatmentComplementary and Alternative Medicine StudiesPharmacogenetics and Drug Metabolism

HIV/AIDS: Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects

Lee, Lawrence S., Andrade, Adriana S. A., Flexner, Charles·2006·Clinical Infectious Diseases

Abstract

Concurrent use of natural health products (NHPs) with antiretroviral drugs (ARVs) is widespread among human immunodeficiency virus-infected patients. This article reviews the clinical pharmacokinetic and pharmacodynamic interactions between NHPs and ARVs. Many NHPs are complex mixtures and are likely to contain organic compounds that may induce and/or inhibit drug metabolizing enzymes and drug transporters. Although the weight of evidence for the effects of certain NHPs varies and many studies of these products lack scientific rigor, it has been observed that St. John's wort clearly induces cytochrome P450 3A4 and P-glycoprotein and reduces protease inhibitor and nonnucleoside reverse-transcriptase inhibitor concentrations, thereby increasing the likelihood of therapeutic failure. Limited clinical research suggests that intake of garlic and vitamin C results in reductions in ARV concentrations. The intake of milk thistle, Echinacea species, and goldenseal inhibits cytochrome P450 enzymes in vitro and may increase ARV concentrations, but by clinically unimportant amounts. Intake of fish oil reduces ARV-induced hypertriglyceridemia without significantly affecting lopinavir concentrations. Before recommending the use of NHPs as adjuncts to ARV use, studies should first exclude significant pharmacokinetic interactions and ensure that ARV efficacy is maintained.

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Crossref · 10.1086/507894

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Authors
Lee, L. S., Andrade, A. S. A., & Flexner, C.
Affiliations
Johns Hopkins University (US)
Corresponding author
Flexner, Charles
Venue
Clinical Infectious Diseases
Published
2006-10-15
Volume
43
Issue
8
Pages
1052-1059
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
OpenAlex
W2111738803
Cited by
102
References
78
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 8 · 2012: 14
FWCI
3.49
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Center for Complementary and Alternative Medicine
  • National Center for Complementary and Integrative Health (F05-AT 02031, F05AT002031)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
Keywords
natural health products, antiretroviral drugs, drug interactions, HIV/AIDS, pharmacokinetic interactions, pharmacodynamic interactions, Hypericum perforatum, CYP3A4, P-glycoprotein, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, garlic, vitamin C, Silybum marianum, Echinacea, goldenseal, fish oil, lopinavir, drug-metabolizing enzymes, drug transporters
MeSH terms
Biological Availability, Cytochrome P-450 Enzyme System, Humans, Plant Extracts, Plants, Medicinal, Glucuronosyltransferase, ATP Binding Cassette Transporter, Subfamily B, Member 1, Herb-Drug Interactions, Anti-Retroviral Agents, Cytochrome P-450 CYP3A

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