Abstract
Integrase strand transfer inhibitors (INSTIs) are an important component of modern combined antiretroviral therapy (cART). The mechanism of inhibition for these antivirals is dependent on magnesium ion binding during attempted HIV-1 replication. Exogenous supplementation of magnesium or other divalent cation minerals may interfere with successful inhibition of HIV replication.
Highlights
Patients infected with HIV-1 co-presenting with anemia or gastroesophageal reflux disease (GERD) will frequently turn to dietary mineral supplements or magnesium/calcium-based antacids to alleviate their symptoms
There is limited data on clinical failure and resultant drug resistance. These two individuals combined cation mineral supplements with integrase strand transfer inhibitors (INSTIs)-combined antiretroviral therapy (cART) leading to increased HIV viremia and drug resistance in one
While prior evidence supports a decrease in bioavailability of dolutegravir when administered with mineral supplements, there is a lack of evidence for other INSTIs available in once daily cART options
Summary
Patients infected with HIV-1 co-presenting with anemia or gastroesophageal reflux disease (GERD) will frequently turn to dietary mineral supplements or magnesium/calcium-based antacids to alleviate their symptoms. These may pose dangers to patients whose HIV regimens include integrase strand transfer inhibitors (INSTIs). Integrase inhibitors are a class of antiretrovirals whose mechanism of action requires divalent cations facilitating a complex between the drug and HIV integrase, with either Mg2+ or Mn2+ being effective both in vivo and in vitro [1].
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