[Correspondence] Itraconazole and antiretroviral therapy: strategies for empirical dosing

In their Review in, Andrew H Limper and colleagues1 highlight the importance of itraconazole for the management of HIV-associated endemic mycoses. Itraconazole is both a substrate and a potent inhibitor of cytochrome P450 3A4 (CYP3A4) and inhibits the membrane transporter P-glycoprotein, resulting in considerable drug–drug interactions with antiretrovirals.2 The reduction of itraconazole exposure when co-administered with the non-nucleotide reverse transcriptase inhibitors (NNRTIs) efavirenz and nevirapine, which are widely-used in developing countries, is particularly concerning.

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