Elinore F McCance-Katz1, Valerie A Gruber, George Beatty, Paula J Lum, Petrie M Rainey. 1. From the Department of Psychiatry (EFM and VAG) and Department of Internal Medicine (GB and PJL), University of California San Francisco; and Department of Laboratory Medicine (PMR), University of Washington, Seattle.
Abstract
OBJECTIVE: Alcohol abuse occurs frequently in those with human immunodeficiency virus (HIV) infection. Alcohol has been linked to poor response to HIV treatment and more rapid progression of HIV. One possible contributor to such observations is drug interactions between alcohol and antiretroviral (ARV) medications. This study examined drug interactions between antiretroviral therapies (ARTs) containing either efavirenz or ritonavir with alcohol. METHODS:Human immunodeficiency virus-infected individuals not currently receiving ARTs participated in a randomized, double-blind, placebo-controlled study in which alcohol (or placebo) was administered and followed by blood sampling for pharmacokinetics, subjective, cardiovascular, and neuropsychological responses obtained at predetermined times. Antiretroviral therapy was then initiated and alcohol (or placebo) sessions were repeated after at least 2 weeks of observed ART. RESULTS:Blood alcohol concentrations (BAC) were lower after ART in a pattern consistent with decreased bioavailability. No effect of alcohol on ritonavir or efavirenz pharmacokinetics was observed. A pharmacodynamic interaction between alcohol and efavirenz was observed as evidenced by no change in intoxication or drowsiness before and after efavirenz ART despite lower BAC. CONCLUSIONS: These results show the effectiveness of implementing ART and its role in diminution of BAC, which could be associated with decreased risk of physiological toxicities related to alcohol consumption relative to those with untreated HIV infection. A potential pharmacodynamic interaction between alcohol and efavirenz was observed as demonstrated by a lack of decline in ratings of intoxication and drowsiness despite decreased BAC. Alcohol consumption did not alter the pharmacokinetics of ritonavir or efavirenz.
RCT Entities:
OBJECTIVE:Alcohol abuse occurs frequently in those with humanimmunodeficiency virus (HIV) infection. Alcohol has been linked to poor response to HIV treatment and more rapid progression of HIV. One possible contributor to such observations is drug interactions between alcohol and antiretroviral (ARV) medications. This study examined drug interactions between antiretroviral therapies (ARTs) containing either efavirenz or ritonavir with alcohol. METHODS:Humanimmunodeficiency virus-infected individuals not currently receiving ARTs participated in a randomized, double-blind, placebo-controlled study in which alcohol (or placebo) was administered and followed by blood sampling for pharmacokinetics, subjective, cardiovascular, and neuropsychological responses obtained at predetermined times. Antiretroviral therapy was then initiated and alcohol (or placebo) sessions were repeated after at least 2 weeks of observed ART. RESULTS:Blood alcohol concentrations (BAC) were lower after ART in a pattern consistent with decreased bioavailability. No effect of alcohol on ritonavir or efavirenz pharmacokinetics was observed. A pharmacodynamic interaction between alcohol and efavirenz was observed as evidenced by no change in intoxication or drowsiness before and after efavirenzART despite lower BAC. CONCLUSIONS: These results show the effectiveness of implementing ART and its role in diminution of BAC, which could be associated with decreased risk of physiological toxicities related to alcohol consumption relative to those with untreated HIV infection. A potential pharmacodynamic interaction between alcohol and efavirenz was observed as demonstrated by a lack of decline in ratings of intoxication and drowsiness despite decreased BAC. Alcohol consumption did not alter the pharmacokinetics of ritonavir or efavirenz.
Authors: Bryan A Ward; J Christopher Gorski; David R Jones; Stephen D Hall; David A Flockhart; Zeruesenay Desta Journal: J Pharmacol Exp Ther Date: 2003-04-03 Impact factor: 4.030
Authors: Elke S Perloff; Su X Duan; Paul R Skolnik; David J Greenblatt; Lisa L von Moltke Journal: Drug Metab Dispos Date: 2005-03-11 Impact factor: 3.922
Authors: E F McCance-Katz; L H Price; C J McDougle; T R Kosten; J E Black; P I Jatlow Journal: Psychopharmacology (Berl) Date: 1993 Impact factor: 4.530
Authors: R S Braithwaite; J Conigliaro; M S Roberts; S Shechter; A Schaefer; K McGinnis; M C Rodriguez; L Rabeneck; K Bryant; A C Justice Journal: AIDS Care Date: 2007-04
Authors: Usama Bilal; Bryan Lau; Mariana Lazo; Mary E McCaul; Heidi E Hutton; Mark S Sulkowski; Richard D Moore; Geetanjali Chander Journal: AIDS Patient Care STDS Date: 2016-05 Impact factor: 5.078
Authors: Kirsha S Gordon; E Jennifer Edelman; Amy C Justice; David A Fiellin; Kathleen Akgün; Stephen Crystal; Mona Duggal; Joseph L Goulet; David Rimland; Kendall J Bryant Journal: AIDS Behav Date: 2017-05
Authors: Amy C Justice; Kathleen A McGinnis; Janet P Tate; R Scott Braithwaite; Kendall J Bryant; Robert L Cook; E Jennifer Edelman; Lynn E Fiellin; Matthew S Freiberg; Adam J Gordon; Kevin L Kraemer; Brandon D L Marshall; Emily C Williams; David A Fiellin Journal: Drug Alcohol Depend Date: 2016-01-29 Impact factor: 4.492
Authors: Emily C Williams; Judith A Hahn; Richard Saitz; Kendall Bryant; Marlene C Lira; Jeffrey H Samet Journal: Alcohol Clin Exp Res Date: 2016-09-22 Impact factor: 3.455
Authors: Robert Gross; Scarlett L Bellamy; Bakgaki Ratshaa; Xiaoyan Han; Andrew P Steenhoff; Mosepele Mosepele; Gregory P Bisson Journal: Addiction Date: 2016-09-07 Impact factor: 6.526