The human immunodeficiency virus (HIV) contains genetic information in the form of RNA. When HIV infects a human T cell, it must convert this RNA to DNA. It does so by using an enzyme called reverse transcriptase. Reverse transcriptase inhibitors interfere with this process.
There are two major categories of reverse transcriptase inhibitors: nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) .
Reverse transcriptase inhibitors include:
- Combivir (lamivudine and zidovudine)
- Emtriva (emtricitabine)
- Epivir (lamivudine)
- Epzicom (abacavir and lamivudine)
- Hivid (zalcitabine)
- Rescriptor (delaviridine)
- Retrovir (AZT, zidovudine)
- Trizivir (abacavir-lamivudine-zidovudine)
- Truvada (emtricitabine-tenofovir)
- Videx (didanosine)
- Viramune (nevirapine)
- Viread (tenofovir)
- Zerit (stavudine)
- Ziagen (abacavir)
The reverse transcriptase inhibitors lamivudine and zidovudine can cause damage to the mitochondria, the energy-producing subunits of cells. This may lead to symptoms such as lactic acidosis (a dangerous metabolic derangement), peripheral neuropathy (injury to nerves in the extremities), and lipodystrophy (cosmetically undesirable rearrangement of fat in the body). The supplement CoQ 10 has been tried for minimizing these side effects. In one double-blind , placebo-controlled study, use of CoQ 10 improved general sense of well-being in people with HIV infection using reverse transcriptase inhibitors; however, for reasons that are unclear, it actually worsened symptoms of peripheral neuropathy. 1 For this reason, people with HIV who have peripheral neuropathy symptoms should use CoQ 10 only with caution.
Use of the herb St. John’s wort can lower blood levels of numerous medications, including protease inhibitors used for HIV. Case reports indicate St. John’s wort also lowers blood levels of the non-nucleoside reverse transcriptase inhibitor nevirapine. 2 The bottom line: If you have HIV, do not take St. John's wort! Furthermore, if you have been stabilized on HIV medications while taking St. John's wort, if you stop taking the herb your blood levels of the drugs could rise, potentially leading to increased side effects.
References
REF1 Christensen ER, Stegger M, Jensen-Fangel S, et al. Mitochondrial DNA levels in fat and blood cells from patients with lipodystrophy or peripheral neuropathy and the effect of 90 days of high-dose coenzyme Q treatment: a randomized, double-blind, placebo-controlled pilot study. Clinical Infectious Diseases . 2004;39:1371–1379.
REF2 de Maat MM, Hoetelmans RM, Mathot RA, et al. Drug interaction between St. John’s wort and nevirapine [letter]. AIDS. 2001;15:420–421.