Analysis of Potential Interaction between Antiretrovirals and Comorbid Medications of HIV Patients at a Top Referral Hospital in Indonesia

Nafrialdi Nafrialdi1, 2, *, Syelvia Moulita3, Instiaty Instiaty1, 2, Evy Yunihastuti4
1 Department of Clinical Pharmacology, Faculty of Medicine Universitas Indonesia, CiptoMangunkusumo Hospital, Jakarta, Indonesia
2 Department of Pharmacology and Therapeutics, Faculty of Medicine Universitas Indonesia, Jakarta Universitas Indonesia, CiptoMangunkusumo Hospital, Jakarta , Indonesia
3 Department of Pharmacology and Therapeutics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
4 Allergy Immunology Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

© 2020 Nafrialdi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta-Indonesia; Tel: +62 21 31930481; E-mail:



HIV/AIDS usually present with comorbid diseases such as tuberculosis, pneumonia, toxoplasmosis, fungal infections, etc., that need multiple medications. Potential interaction between ARV and comorbid drugs is unavoidable.


This study aimed to investigate the potential interaction between ARV drugs and medications used to treat comorbid diseases among HIV patients at the Dr. Cipto Mangunkusumo Hospital, Jakarta.


This was an observational study using medical record data of 121 HIV/AIDS patients treated at the CM Hospital between January 2016 and July 2017. Potential interaction was classified as “major” if it could lead to increase or decrease of plasma drug levels which potentially result in either drug toxicity or treatment failure, or clinically significant harm to the patient; “moderate” if the interaction is not major, but with the recommendation of close monitoring. National, European, Australian, and Liverpool iChart guidelines were used for the classification of drug interactions.


Major interactions were noted in 17 (14.05%)patients. Fourteen of them received rifampicin, which potentially decreases plasma level of nevirapine (9 patients), rilpivirine (1 patient), and lopinavir/ritonavir (4 patients). Potential increase of ARV level was found in 3 patients involving interaction between voriconazole-efavirenz (2) and omeprazole-rilpivirine (1). Moderate interaction with the potential decrease of ARV level occurred in 46 patients (38.01%); consisting of a combination of rifampicin with efavirenz (38 pts), rifampicin with zidovudine (6 pts), and phenytoin with efavirenz or nevirapine (2 patients).


Potential major interaction occurred in 17 (14.05%), which mostly attributed to rifampicin use; while moderate interaction occurred in 46 (38.01%) of patients. Although no serious adverse event was observed in this study, special care should be taken when the drugs with potential major interaction are to be administered

Keywords: Antiretrovirals, Comorbid, Drug interaction, HIV, AIDS, Rifampicin.