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Anti-Epileptic Choice in HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicineAnti-Epileptic Choice in HIVSCE Infectious Diseases

A 30-year-old man with HIV on ART develops a first seizure. MRI is normal. EEG shows no epileptiform activity. His ART is DTG/TAF/FTC. He is started on Levetiracetam. Why is Levetiracetam preferred over Carbamazepine or Phenytoin in this patient?

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Correct answer: A — Levetiracetam has no significant CYP enzyme-inducing properties and does not interact with ART — Carbamazepine and Phenytoin are potent CYP inducers that reduce DTG levels

Enzyme-inducing anti-epileptic drugs (Carbamazepine, Phenytoin, Phenobarbital) are potent CYP3A4/UGT1A1 inducers that significantly reduce levels of many ART agents including DTG, BIC, RPV, and PIs. Levetiracetam, Lamotrigine (minor interactions), Sodium Valproate (teratogenic in women — use cautiously), and Lacosamide have minimal enzyme-inducing properties and are preferred with ART. This principle applies broadly to all PLWH on ART requiring anti-epileptic therapy.

Reference: BHIVA 2025 – ART guidelines; BNF 2024 – Anti-epileptic interactions; Liverpool Drug Interactions