Virological Failure Associated with the Concomitant Use of Red Yeast Rice and Dolutegravir/Abacavir/Lamivudine in an HIV-1 Patient: A Case Report

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.