Virological Failure Associated with the Concomitant Use of Red Yeast Rice and Dolutegravir/Abacavir/Lamivudine in an HIV-1 Patient: A Case Report
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Abstract
Red yeast rice (RYR) is increasingly used for cholesterol management but contains monacolin K, which is
chemically identical to lovastatin, and may interact with antiretroviral therapy via CYP3A4 and P-glycoprotein
pathways. We report the case of a 47-year-old man with well-controlled HIV-1 infection receiving dolutegravir/
abacavir/lamivudine who experienced virological rebound after self-initiating RYR supplementation. Eight
weeks after starting RYR (77.7 mg daily, with a labeled monacolin K content of 3 mg), the patient developed
virological rebound (897 copies/mL) despite confirmed adherence and absence of resistance mutations. Following pharmacist-led discontinuation of RYR, viral suppression (<50 copies/mL) was restored within eight weeks without modification of antiretroviral therapy. This represents the first documented case of RYR-associated virological failure in HIV treatment. Hospital pharmacists should routinely screen for herbal supplements and provide patient education regarding potential interactions with antiretroviral medications.
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| Files | ||
| Issue | Vol 13, No 4 (Autumn 2025) | |
| Section | Case Report(s) | |
| Keywords | ||
| Pharmaceutical Care Drug Interactions HIV Red Yeast Rice Dolutegravir Medication Safety Herbal Supplements | ||
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