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Complementary and alternative medicine in HIV care: frequency of consumption, risks and interactions with antiretroviral therapy
  1. Elena Colominas-González1,2,
  2. Marta De Antonio1,
  3. Montserrat Masip3,
  4. Maria Teresa Martin Conde4,
  5. Glòria Cardona5,
  6. Daniel Fresán Restituto6,
  7. Dolors Comas7,
  8. Maria Angeles Roch8,
  9. Belen López9,
  10. Francisco Ignacio Torres-Bondia10,
  11. Alexandra Retamero11,
  12. Hernando Knobel12,
  13. Sonia Luque1,13,14
    1. 1Pharmacy Department, Hospital del Mar, Barcelona, Spain
    2. 2Medicine Department, Universitat Pompeu Fabra, Barcelona, Spain
    3. 3Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
    4. 4Pharmacy Department, Hospital Clinic de Barcelona, Barcelona, Spain
    5. 5Pharmacy Department, Hospital Germans Trias i Pujol, Badalona, Spain
    6. 6Pharmacy Department, Hospital García Orcoyen, Estella, Spain
    7. 7Pharmacy Department, Hospital Bellvitge Barcelona, Barcelona, Spain
    8. 8Pharmacy Department, Hospital Joan XXIII, Tarragona, Spain
    9. 9Pharmacy Department, Hospital Parc Tauli, Sabadell, Spain
    10. 10Pharmacy Department, Hospital Universitario Santa Maria, Lleida, Spain
    11. 11Pharmacy Department, Hospital d'Igualada, Igualada, Spain
    12. 12Infectious Diseases Department, Hospital del Mar, Barcelona, Spain
    13. 13Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
    14. 14CIBER of Infectious Diseases (CIBERINFEC CB21/13/0002), Institute of Health Carlos III, Madrid, Spain
    1. Correspondence to Dr Sonia Luque, Pharmacy Department, Hospital del Mar, Barcelona, Spain; sluque{at}


    Objectives People living with HIV (PLWH) are common users of complementary and alternative medicine (CAM). The main objective of this study was to study the frequency and patterns of CAM natural products use in a large cohort of PLWH and to identify potential drug–drug interactions (DDIs) and the impact on their antiretroviral treatment (ART) adherence and efficacy.

    Methods This was a cross-sectional multicenter survey including 420 PLWH from different Spanish hospitals. Participants completed a face-to-face questionnaire on CAM consumption and different sociodemographic and clinical data were collected. DDIs between CAM and ART were identified and classified according to the Liverpool University Database and patient factors related to CAM consumption were assessed.

    Results 420 participants were included (82.6% male, mean age 47 years); 209 patients (49.8%) were taking at least one CAM. The most consumed CAM were green, black and red tea (n=146, 25.4%), ginger (n=26, 4.5%), fish oil (n=25, 4.4%) and cannabis (n=24, 4.2%). An ART based on integrase inhibitors was the only factor independently associated with CAM consumption (OR 1.54, 95% CI 1.04 to 2.26). 50 potential CAM–ART interactions in 43 (20.6%) patients taking CAM were identified, being clinically significant in 80% of the cases. CAM products most frequently involved with a potential significant DDI were supplements containing divalent cations (n=11) and garlic (n=7). No differences in ART efficacy and adherence were observed between patients with and without CAM consumption.

    Conclusions Almost 50% of patients were taking at least one CAM product and its use was associated with an integrase inhibitor based ART. One out of every six patients was at risk of presenting with an interaction between a CAM and their ART, confirming the need to review continuously the use of CAM as part of the medication review process.

    • HIV

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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