“I’ve been taking something for my stomach and a herbal tablet for my mood — is that okay with my HIV pills?”

Many people with HIV take over-the-counter and herbal products without telling their clinic. Always take a full drug history and check interactions (the Liverpool HIV Drug Interactions website is the standard resource; the HIV clinic pharmacist can advise). St John’s wort induces drug-metabolising enzymes and transporters and must not be taken with Biktarvy and many other antiretrovirals. Polyvalent cations (aluminium, magnesium, calcium, iron) chelate integrase inhibitors: take Biktarvy at least 2 hours before antacids. PPIs are compatible with Biktarvy but contraindicated with rilpivirine and atazanavir — check the regimen. Low mood is common in people living with HIV and is often linked to stigma and disclosure. U=U (undetectable = untransmittable): a person with a sustained undetectable viral load cannot transmit HIV sexually. In England and Wales criminal cases concern actual transmission; being on effective treatment with an undetectable viral load means sexual transmission will not occur. Support disclosure decisions; reassure about confidentiality; share information with the HIV clinic with consent.