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Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis


  1. Burman W, Benator D, Vernon A, et al. Acquired rifamycin resistance with twice-weekly treatment of HIV-related tuberculosis. Am J Respir Crit Care Med. Feb 1 2006;173(3):350-356.
  2. Hung CC, Chen MY, Hsiao CF, Hsieh SM, Sheng WH, Chang SC. Improved outcomes of HIV-1-infected adults with tuberculosis in the era of highly active antiretroviral therapy. AIDS. Dec 5 2003;17(18):2615-2622.
  3. Burman WJ. Issues in the management of HIV-related tuberculosis. Clin Chest Med. Jun 2005;26(2):283-294.
  4. Burger DM, Meenhorst PL, Koks CHW, Beijnen JH. Pharmacokinetic interaction between rifampin and zidovudine. Antimicrob Agents Chemother. 1993;37:1426-1431.
  5. Jindani A, Nunn AJ, Enarson DA. Two 8-month regimens of chemotherapy for treatment of newly diagnosed pulmonary tuberculosis: international multicentre randomised trial. Lancet. Nov 2 2004;364(9441):1244-1251.
  6. Okwera A, Whalen C, Byekwaso F, et al. Randomised trial of thiacetazone and rifampicin-containing regimens for pulmonary tuberculosis in HIV-infected Ugandans. The Makerere University-Case Western University Research Collaboration [see comments]. Lancet. 1994;344(8933):1323-1328.
  7. Nettles RE, Mazo D, Alwood K, et al. Risk factors for relapse and acquired rifamycin resistance after directly observed tuberculosis treatment: a comparison by HIV serostatus and rifamycin use. Clin Infect Dis. Mar 1 2004;38(5):731-736.
  8. Acquired rifamycin resistance in persons with advanced HIV disease being treated for active tuberculosis with intermittent rifamycin-based regimens. MMWR Morb Mortal Wkly Rep. 2002;51(10):214-215.
  9. Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. Feb 15 2003;167(4):603-662.
  10. Gallicano K, Sahai J, Shukla VK, Cameron DW. Induction of zidovudine glucuronidation and amination pathways by rifampin in HIV infected patients. Br J Clin Pharmacol. 1999;48:168-179.
  11. Lopez-Cortes LF, Ruiz-Valderas R, Viciana P, et al. Pharmacokinetic interactions between efavirenz and rifampicin in HIV-infected patients with tuberculosis. Clin Pharmacokinet. 2002;41(9):681-690.
  12. Manosuthi W, Kiertiburanakul S, Sungkanuparph S, et al. Efavirenz 600 mg/day versus efavirenz 800 mg/day in HIV-infected patients with tuberculosis receiving rifampicin: 48 weeks results. AIDS. Jan 2 2006;20(1):131-132.
  13. Manosuthi W, Sungkanuparph S, Thakkinstian A, et al. Efavirenz levels and 24-week efficacy in HIV-infected patients with tuberculosis receiving highly active antiretroviral therapy and rifampicin. Aids. Sep 23 2005;19(14):1481-1486.
  14. Sungkanuparph S, Manosuthi W, Kiertiburanakul S, Vibhagool A. Initiation of antiretroviral therapy in advanced AIDS with active tuberculosis: clinical experiences from Thailand. J Infect. Jun 28 2005.
  15. Patel A, Patel K, Patel J, Shah N, Patel B, Rani S. Safety and antiretroviral effectiveness of concomitant use of rifampicin and efavirenz for antiretroviral-naive patients in India who are coinfected with tuberculosis and HIV-1. J Acquir Immune Defic Syndr. Sep 1 2004;37(1):1166-1169.
  16. Brennan-Benson P, Lyus R, Harrison T, Pakianathan M, Macallan D. Pharmacokinetic interactions between efavirenz and rifampicin in the treatment of HIV and tuberculosis: one size does not fit all. AIDS. Sep 23 2005;19(14):1541-1543.
  17. Ribera E, Pou L, Lopez RM, et al. Pharmacokinetic interaction between nevirapine and rifampicin in HIV- infected patients with tuberculosis. J Acquir Immune Defic Syndr. 2001;28(5):450-453.
  18. Ramachandran G, Hemanthkumar AK, Rajasekaran S, et al. Increasing nevirapine dose can overcome reduced bioavailability due to rifampicin coadministration. J Acquir Immune Defic Syndr. May 2006;42(1):36-41.
  19. Autar RS, Wit FW, Sankote J, et al. Nevirapine plasma concentrations and concomitant use of rifampin in patients coinfected with HIV-1 and tuberculosis. Antivir Ther. 2005;10(8):937-943.
  20. Van Cutsem G, Cohen K, Bedelu M, et al. TB/HIV co-infected patients on rifampin containing treatment have equivalent ART treatment outcomes, and concurrent use of nevirapine is not associated with increased hepatoxicity. Paper presented at: 3rd IAS Conference on HIV Pathogenesis and Treatment; July 24-27, 2005; Rio de Janiero.
  21. Avihingsanon A, Manosuthi W, Kantipong P, et al. Pharmacokinetics and 12 weeks efficacy of nevirapine, 400 mg vs. 600 mg per day in HIV-infected patients with active TB receiving rifampicin: a multicenter study. Paper presented at: 14th Conference on Retroviruses and Opportunistic Infections; February 25-28, 2007; Los Angeles, CA.
  22. Burman WJ, Gallicano K, Peloquin C. Therapeutic implications of drug interactions in the treatment of HIV-related tuberculosis. Clin Infect Dis. 1999;28:419-430.
  23. la Porte CJ, Colbers EP, Bertz R, et al. Pharmacokinetics of adjusted-dose lopinavir-ritonavir combined with rifampin in healthy volunteers. Antimicrob Agents Chemother. May 2004;48(5):1553-1560.
  24. Burger DM, Agarwala S, Child M, Been-Tiktak A, Wang Y, Bertz R. Effect of rifampin on steady-state pharmacokinetics of atazanavir with ritonavir in healthy volunteers. Antimicrob Agents Chemother. 2006;50:3336-3342.
  25. Justesen US, Andersen AB, Klitgaard NA, Brosen K, Gerstoft J, Pedersen C. Pharmacokinetic interaction between rifampin and the combination of indinavir and low-dose ritonavir in HIV-infected patients. Clin Infect Dis. Feb 1 2004;38(3):426-429.
  26. Ribera E, Azuaje C, Lopez RM, et al. Pharmacokinetic interaction between rifampicin and the once-daily combination of saquinavir and low-dose ritonavir in HIV-infected patients with tuberculosis. J Antimicrob Chemother. Apr 2007;59(4):690-697.
  27. Ribera E, Azuaje C, Lopez RM, et al. Once-daily regimen of saquinavir, ritonavir, didanosine, and lamivudine in HIV-infected patients with standard tuberculosis therapy (TBQD Study). J Acquir Immune Defic Syndr. Nov 1 2005;40(3):317-323.
  28. Drug-induced hepatitis with saquinavir/ritonavir + rifampin. AIDS Clin Care. Mar 2005;17(3):32.
  29. Burger D. Unexpected high incidence of nausea, vomiting, and asymptomatic elevations of AST/ALT enzymes in healthy volunteers receiving rifampin + adjusted doses of lopinavir/ritonavir. 8th International Workshop on Clinical Pharmacology of HIVTherapy. Budapest; 2007.
  30. Rolla VC, da Silva Vieira MA, Pereira Pinto D, et al. Safety, efficacy and pharmacokinetics of ritonavir 400mg/saquinavir 400mg twice daily plus rifampicin combined therapy in HIV patients with tuberculosis. Clin Drug Investig. 2006;26(8):469-479.
  31. Gulick RM, Ribaudo HJ, Shikuma CM, et al. Triple-nucleoside regimens versus efavirenz-containing regimens for the initial treatment of HIV-1 infection. N Engl J Med. Apr 29 2004;350(18):1850-1861.
  32. DART Virology Group and Trial Team. Virological response to a triple nucleoside/nucleotide analogue regimen over 48 weeks in HIV-1-infected adults in Africa. AIDS. Jun 26 2006;20(10):1391-1399.
  33. Moyle G, Higgs C, Teague A, et al. An open-label, randomized comparative pilot study of a single-class quadruple therapy regimen versus a 2-class triple therapy regimen for individuals initiating antiretroviral therapy. Antivir Ther. 2006;11(1):73-78.
  34. Srikantiah P, Walusimbi MN, Kayanja HK, et al. Early virological response of zidovudine/lamivudine/abacavir for patients co-infected with HIV and tuberculosis in Uganda. AIDS. Sep 2007;21(14):1972-1974.
  35. Pfizer Labs. Maraviroc package insert. (PDF)
  36. Wang Y, Serradell N, Bolos J, Rosa E. MK-o518. Drugs Fut. 2007;32:118.
  37. Scholler-Gyure M, Woodlfall B, Debroye C, et al. Pharmacokinetic interaction between TMC125 and rifabutin. Paper presented at: Annual Meeting of the Infectious Diseases Society of America; October 12-15, 2006; Toronto.
  38. Schwander S, Rusch-Gerdes S, Mateega A, et al. A pilot study of antituberculosis combinations comparing rifabutin with rifampicin in the treatment of HIV-1 associated tuberculosis: a single-blind randomized evaluation in Ugandan patients with HIV-1 infection and pulmonary tuberculosis. Tubercle Lung Dis. 1995;76:210-218.
  39. Gonzalez-Montaner LJ, Natal S, Yonchaiyud P, Olliaro P. Rifabutin for the treatment of newly-diagnosed pulmonary tuberculosis: a multinational, randomized, comparative study versus rifampicin. Tubercle Lung Dis. 1994;75:341-347.
  40. Perucca E, Grimaldi R, Frigo GM, Sardi A, Monig H, Ohnhaus EE. Comparative effects of rifabutin and rifampicin on hepatic microsomal enzyme activity in normal subjects. Eur J Clin Pharmacol. 1988;34:595-599.
  41. Narita M, Stambaugh JJ, Hollender ES, Jones D, Pitchenik AE, Ashkin D. Use of rifabutin with protease inhibitors for human immunodeficiency virus-infected patients with tuberculosis. Clin Infect Dis. 2000;30:779-783.
  42. Sun E, Heath-Chiozzi M, Cameron DW, et al. Concurrent ritonavir and rifabutin increases risk of rifabutin-associated adverse events. Paper presented at: XI International Conference on AIDS, 1996; Vancouver, Canada.
  43. Sarner L, Fakoya A. Acute onset lactic acidosis and pancreatitis in the third trimester of pregnancy in HIV-1 positive women taking antiretroviral medication. Sex Transm Infect. Feb 2002;78(1):58-59.
  44. Leith J, Piliero P, Storfer S, Mayers D, Hinzmann R. Appropriate use of nevirapine for long-term therapy. J Infect Dis. Aug 1 2005;192(3):545-546.
  45. Mirochnick M, Capparelli E. Pharmacokinetics of antiretrovirals in pregnant women. Clin Pharmacokinet. 2004;43(15):1071-1087.
  46. Nellen JF, Schillevoort I, Wit FW, et al. Nelfinavir plasma concentrations are low during pregnancy. Clin Infect Dis. Sep 1 2004;39(5):736-740.
  47. Stek AM, Mirochnick M, Capparelli E, et al. Reduced lopinavir exposure during pregnancy. Aids. Oct 3 2006;20(15):1931-1939.
  48. Lockman S, Shapiro RL, Smeaton LM, et al. Response to antiretroviral therapy after a single, peripartum dose of nevirapine. N Engl J Med. Jan 11 2007;356(2):135-147.
  49. Ren Y, Nuttall J, Egbers C, et al. Plasma concentrations of efavirenz and lopinavir in children with and without rifampicin-based anti-TB treatment. Paper presented at: 14th Conference on Retroviruses and Opportunistic Infections; February 25-28, 2007; Los Angeles, CA.
  50. Moultrie H, Meyers T. Antiretroviral and anti-TB co-therapy in children < 3 years in Soweto, South Africa: outcomes in the first 6 months. Paper presented at: XVI International AIDS Conference; August 13-18, 2006; Toronto.
  51. World Health Organization. Antiretroviral therapy of HIV infection in infants and children: toward universal access: WHO Press; 2006:1-152.
  52. Ren Y, Nuttall JJ, Egbers C, et al. High prevalence of subtherapeutic plasma concentrations of efavirenz in children. J Acquir Immune Defic Syndr. Jun 1 2007;45(2):133-136.
  53. McKinney RE, Jr., Rodman J, Hu C, et al. Long-term safety and efficacy of a once-daily regimen of emtricitabine, didanosine, and efavirenz in HIV-infected, therapy-naive children and adolescents: Pediatric AIDS Clinical Trials Group Protocol P1021. Pediatrics. Aug 2007;120(2):e416-423.
  54. Funk MB, Notheis G, Schuster T, et al. Effect of first line therapy including efavirenz and two nucleoside reverse transcriptase inhibitors in HIV-infected children. Eur J Med Res. Dec 7 2005;10(12):503-508.
  55. Gandhi NR, Moll A, Sturm AW, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. Nov 4 2006;368(9547):1575-1580.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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