A patient with HIV who is stable on dolutegravir plus two NRTIs reports taking a calcium supplement daily. The physician advises separating the dolutegravir dose from the calcium by at least 2 hours. Which other antiretroviral class shares this same cation interaction?

• A Integrase strand transfer inhibitors (INSTIs) ✓
• B Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• C Nucleoside reverse transcriptase inhibitors (NRTIs)
• D Protease inhibitors (PIs)

Explanation

All INSTIs (raltegravir, elvitegravir, dolutegravir, bictegravir) chelate divalent cations (calcium, iron, magnesium, aluminum) in antacids and supplements, reducing absorption. Dolutegravir should be taken 2 hours before or 6 hours after cation-containing products. Raltegravir is similarly affected. NRTIs, NNRTIs, and PIs do not have this significant cation interaction.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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