Antiretroviral Drug Interactions with Acid-Reducing Agents

Mechanism of Interaction and Clinical Implications

• Ledipasvir, used in HCV/HIV coinfection, has decreased solubility as pH increases, requiring careful management with acid-reducing agents, according to the Journal of Hepatology 1
• Daclatasvir, sofosbuvir, and raltegravir do not have clinically significant interactions with antacids, as reported by Clinical and Molecular Hepatology 2 and 3

Important Caveats and Monitoring Recommendations

• The interaction between atazanavir and acid-reducing agents extends beyond antacids to include proton pump inhibitors and H2-receptor antagonists, as noted in the Journal of Hepatology 1
• Monitoring HIV viral load more frequently is recommended for patients on atazanavir who require acid-reducing therapy, to ensure continued virologic suppression, according to Clinical and Molecular Hepatology 3