- Design
- Descriptive analysis of interaction-checker queries, 2020–2024
- Population
- 7,274,301 queries from 48 countries
- Primary outcome
- Trends in antiretrovirals, co-medications and interaction severity
- Effect
- Queries +441%; red and amber interactions fell 3 and 6 points; green rose 9 points
This analysis covered 7,274,301 queries submitted to the University of Liverpool HIV Drug Interactions Database from 48 countries between 2020 and 2024, a 441% rise over five years.
Dolutegravir (21%) and bictegravir (20%) were the most queried antiretrovirals, and queries involving unboosted integrase inhibitors grew. The commonest co-medication classes were antibacterials, lipid-lowering drugs and supplements or vitamins. Over the period, the share of amber and red (potentially or definitely significant) interactions fell by 6 and 3 percentage points, and green rose by 9.
Mechanistically this fits the move away from ritonavir- and cobicistat-boosted regimens, which inhibit CYP3A strongly, towards unboosted integrase inhibitors with fewer enzyme effects. Fewer severe interactions does not mean none: dolutegravir and bictegravir still chelate with polyvalent cations, and supplements were among the most checked co-medications. India's national programme now uses dolutegravir-based first-line regimens widely, so these checks are routine prescribing, not specialist work.
- Separate dolutegravir or bictegravir from iron, calcium, magnesium and aluminium supplements or antacids, per labelling.
- Ask people with HIV specifically about vitamins and supplements; they were among the most checked co-medications.
- Check statin choice and dose against boosted regimens, which still raise many statin levels.
- Use a dedicated HIV interaction checker before starting any new drug in a patient on antiretrovirals.
Why it matters
As people with HIV age, co-prescribing by non-HIV clinicians is where interactions now arise.
Don't overread it
Query counts reflect what prescribers checked, not what patients actually received or any harm.
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