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Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis

Table 1. Recommendations for Regimens for the Concomitant Treatment of Tuberculosis and HIV Infection

Combined regimen for treatment of HIV and tuberculosis PK effect of the rifamycin Tolerability / toxicity Antiviral activity when used with rifampin Recommendation(comments)

Efavirenz-based antiretroviral therapy* with rifampin-based TB treatment

Well-characterized, modest effect

Low rates of discontinuation

Excellent

Preferred (efavirenz should not be used during the first trimester of pregnancy)

PI-based antiretroviral therapy* with rifabutin-based TB treatment

Little effect of rifabutin on PI concentrations, but marked increases in rifabutin concentrations

Low rates of discontinuation (if rifabutin is appropriately dose-reduced)

Favorable, though published clinical experience is not extensive

Preferred for patients unable to take efavirenz †

Nevirapine-based antiretroviral therapy with rifampin-based TB treatment

Moderate effect

Concern about hepatotoxicity when used with isoniazid, rifampin and pyrazinamide

Favorable

Alternative for patients who cannot take efavirenz and if rifabutin not available

Zidovudine / lamivudine / abacavir / tenofovir with rifampin-based TB treatment10

50% decrease in zidovudine, possible effect on abacavir not evaluated

Anemia

No published clinical experience

Alternative for patients who cannot take efavirenz and if rifabutin not available

Zidovudine / lamivudine / tenofovir with rifampin-based TB treatment

50% decrease in zidovudine, no other effects predicted

Anemia

Favorable, but not evaluated in a randomized trial

Alternative for patients who cannot take efavirenz and if rifabutin not available

Zidovudine / lamivudine / abacavir  with rifampin-based TB treatment

50% decrease in zidovudine, possible effect on abacavir not evaluated

Anemia

Early favorable experience, but this combination is less effective than efavirenz-based regimens in persons not taking rifampin

Alternative for patients who cannot take efavirenz and if rifabutin not available

Super-boosted lopinavir-based ART with rifampin-based TB treatment

Little effect

Hepatitis among healthy adults, but favorable experience, among young children (< 3 years)

Good, among young children (< 3 years)

Alternative if rifabutin not available; preferred for young children when rifabutin not available

ART=antiretrovirol therapy
* with 2 nucleoside analogues
† includes patients with NNRTI-resistant HIV, those unable to tolerate efavirenz, women during the first 1-2 trimesters of pregnancy

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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