Weight-loss pharmacotherapies may be used to manage obesity in HIV patients, however, healthcare providers should be aware of the possibility of loss of HIV viremia control when combining these medications with antiretrovirals agents, according to the findings of a recent review. 

To investigate potential drug-drug interactions between anti-obesity drugs and antiretroviral therapy (ART), study authors conducted a search using PubMed, MEDLINE, Google Scholar, and EMBASE to obtain literature published between October 2018 and September 2019 that analyzed the safety and efficacy of Food & Drug Administration (FDA)-approved weight loss medications in persons living with HIV. They identified and included a total of 2 case reports, 2 case series, 6 ART-specific pharmacokinetic studies, 36 clinical trials, and 13 package inserts in their review. 

“Persons living with HIV are frequently not reported or included in clinical trials for weight-loss medications, however, treatment efficacy is likely similar to the general population,” the study authors reported. Several case reports obtained during their search, however, did discuss the possibility of HIV viral rebound in patients taking orlistat

“Several important reported or theoretical drug-drug interactions exist between anti-obesity pharmacotherapy and antiretroviral therapy,” the authors stated. The report highlighted several mechanisms in which anti-obesity medications could interact with antiretroviral agents, such as the change in absorption of a medication (ie, concomitant use of orlistat and non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors) and inhibition or induction of cytochrome P450 (CYP) enzymes (ie, inhibition of CYP2D6 by lorcaserin); in general, the authors recommended avoiding the use of orlistat in patients on ART. Liraglutide was noted to be one of the weight-loss medications that had minimal drug interactions. 

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As for naltrexone-bupropion, increased monitoring is recommended when the drug is co-administered with ritonavir-boosted protease inhibitors, efavirenz, nevirapine, or cobicistat-containing regimens. While there appears to be a low risk of interaction between phentermine-topiramate and ART, factors such as prescription abuse and cardiovascular disease should be considered before starting therapy with this agent.

Based on their findings, the authors concluded that in addition to lifestyle modifications, clinicians should consider FDA-approved weight loss medications to manage and treat obesity in patients with HIV. “Each agent has its own specific caveats, counseling points, and monitoring parameters, which should be considered when combined with ART,” they noted. 

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