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Review
. 2011 Jul;10(4):559-74.
doi: 10.1517/14740338.2011.546783. Epub 2011 Jan 5.

Initiating antiretrovirals during tuberculosis treatment: a drug safety review

Tanuja N Gengiah  1 , Andrew L Gray, Kogieleum Naidoo, Quarraisha Abdool Karim
Affiliations
Review

Initiating antiretrovirals during tuberculosis treatment: a drug safety review

Tanuja N Gengiah et al. Expert Opin Drug Saf. 2011 Jul.

Abstract

Introduction: Integrating HIV and tuberculosis (TB) treatment can reduce mortality substantially. Practical barriers to treatment integration still exist and include safety concerns related to concomitant drug use because of drug interactions and additive toxicities. Altered therapeutic concentrations may influence the chances of treatment success or toxicity.

Areas covered: The available data on drug-drug interactions between the rifamycin class of anti-mycobacterials and the non-nucleoside reverse transcriptase inhibitor and the protease inhibitor classes of antiretrovirals are discussed with recommendations for integrated use. Additive drug toxicities, the impact of immune reconstitution inflammatory syndrome (IRIS) and the latest data on survival benefits of integrating treatment are elucidated.

Expert opinion: Deferring treatment of HIV to avoid drug interactions with TB treatment or the occurrence of IRIS is not necessary. In the integrated management of TB-HIV co-infection, rational drug combinations aimed at reducing toxicities while effecting TB cure and suppressing HIV viral load are possible.

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Conflict of interest statement

Declaration of interest

The authors state no conflict of interest and have received no payment in preparation of this manuscript

Figures

Figure 1
Figure 1
Drug interactions following oral administration may be mediated at four stages of disposition [15]
Figure 1
Figure 1
Possible metabolic drug interactions and the cytochrome (CYP) P450 system
See this image and copyright information in PMC

References

    1. UNAIDS. AIDS epidemic update December 2009. 2009. [cited 28 July 2010]. Available from: http://data.unaids.org/pub/Report/2009/JC1700_Epi_Update_2009_en.pdf.
    1. World Health Organization. Global tuberculosis control: a short update to the 2009 report. 2009.
    1. Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection-associated tuberculosis: the epidemiology and the response. Clin Infect Dis. 2010 May 15;50 Suppl 3:S201–S207. - PubMed
    1. Gandhi NR, Shah NS, Andrews JR, Vella V, Moll AP, Scott M, et al. HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality. Am J Respir Crit Care Med. 2009 Jan 1;181(1):80–86. - PubMed
    1. Habib AG. A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults. Ann Afr Med. 2009 Jul–Sep;8(3):147–155. - PubMed

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