{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T12:07:10Z","timestamp":1758629230327,"version":"3.37.3"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T00:00:00Z","timestamp":1720828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Unitaid"},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We investigated the impact of Drug\u2013Drug Interactions (DDIs) on virologic control among HIV-positive pregnant women initiating antiretroviral therapy while identifying drivers for Traditional Medicine (TM) use and exploring the nature and extent of TM-related DDIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Employing a three-pronged approach, we examined DDIs arising from comedication, including TM, in ART. The DolPHIN-2 trial (NCT03249181) randomized 268 HIV-positive pregnant women in Uganda and South Africa to dolutegravir (DTG)-based (135) or efavirenz-based (133) regimens while systematically recording comedications and screening for DDIs. We used Cox regression models to compare time-to-virologic control between participants with and without DDIs. We conducted in-depth interviews and focus group discussions among 37 and 67 women with and without HIV, respectively, to explore reasons for TM use during pregnancy. Additionally, in-vitro and in-vivo studies evaluated the composition and impact of clay-based TM, mumbwa, on DTG plasma exposure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The baseline prevalence of DDIs was 67.2%, with TM use prevalent in 34% of participants, with mumbwa being the most frequent (76%, 69\/91). There was no difference in virologic response between participants with and without DDIs. Fetal health and cultural norms were among the reasons cited for TM use. Analysis of mumbwa rods confirmed significant amounts of aluminium (8.4%\u201313.9%) and iron (4%\u20136%). In Balb-C mice, coadministration of mumbwa led to a reduction in DTG exposure observed in the AUC0-24 (\u221221%; P\u200a=\u200a0.0271) and C24 (\u221253%; P\u200a=\u200a0.0028).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The widespread use of clay-based TM may compromise HIV treatment, necessitating medication screening and counselling to manage DDIs in pregnant women.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkae232","type":"journal-article","created":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T01:53:42Z","timestamp":1720835622000},"page":"2334-2342","source":"Crossref","is-referenced-by-count":1,"title":["Clinical, pharmacological, and qualitative characterization of drug\u2013drug interactions in pregnant women initiating HIV therapy in Sub-Saharan Africa"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1054-6141","authenticated-orcid":false,"given":"Daniel","family":"Kiiza","sequence":"first","affiliation":[{"name":"Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University , Kampala , Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danial","family":"Rostami-Hochaghan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yussif","family":"Alhassan","sequence":"additional","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kay","family":"Seden","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian P","family":"Kaboggoza","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University , Kampala , Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Taegtmeyer","sequence":"additional","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Challenger","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thokozile","family":"Malaba","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town , Cape Town , South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duolao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Else","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , 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UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catriona","family":"Waitt","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University , Kampala , Uganda"},{"name":"Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Orrell","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town , South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0389-9934","authenticated-orcid":false,"given":"Angela","family":"Colbers","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Radboud Institute for Medical Innovations (RIMI), Radboud University Medical Center , Nijmegen , 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