Antiretrovirals and Tuberculosis Therapy

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Last updated April 30, 2015
Case Authors: 
Bradley W. Kosel, PharmD
Clinical Assistant Professor
Department of Pharmacy
University of Washington School of Pharmacy
David H. Spach, MD's picture
David H. Spach, MD
Professor of Medicine
Division of Infectious Diseases
Clinical Director
Northwest AIDS Education and Training Center
University of Washington School of Medicine 
Learning Objectives: 
  1. Understand the drug-drug interactions that occur with rifamycins (rifampin and rifabutin) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs).
  2. Understand the drug-drug interactions that occur with rifamycins (rifampin and rifabutin) and the protease inhibitors (PIs).

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References
  1. Burman WJ, Gallicano K, Peloquin C. Therapeutic implications in the treatment of human immunodeficiency virus-related tuberculosis. Clin Infect Dis. 1999; 28:419-430.
  2. Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. MMWR Recomm Rep. 1998;47(No. RR-20):1-78.
  3. Centers for Disease Control and Prevention (CDC). Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis. 2007.
  4. Gallicano KD, Sahai J, Shukla VK, et al. Induction of zidovudine glucuronidation and amination pathways by rifampicin in HIV-infected patients. Br J Clin Pharmacol. 1999;48:168-79.
  5. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Drug interactions: drug interactions between nucleoside reverse transcriptase inhibitors and other drugs (including antiretroviral agents). April 8, 2015.
  6. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Drug interactions: drug interactions between non-nucleoside reverse transcriptase inhibitors and other drugs. April 8, 2015.
  7. 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. 2006;20:131-2.
  8. 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. 2005;19:1541-3.
  9. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Drug interactions: drug interactions between protease inhibitors and other drugs. April 8, 2015.
  10. Castellino S, Moss L, Wagner D, et al. Metabolism, excretion, and mass balance of the HIV-1 integrase inhibitor dolutegravir in humans. Antimicrob Agents Chemother. 2013;57:3536-46.
  11. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Drug interactions: drug interactions between integrase inhibitors and other drugs. April 8, 2015.
  12. Wenning LA, Hanley WD, Brainard DM, et al. Effect of rifampin, a potent inducer of drug-metabolizing enzymes, on the pharmacokinetics of raltegravir. Antimicrob Agents Chemother. 2009;53:2852-6.
  13. Brainard DM, Kassahun K, Wenning LA, et al. Lack of a clinically meaningful pharmacokinetic effect of rifabutin on raltegravir: in vitro/in vivo correlation. J Clin Pharmacol. 2010;51:943-50.
  14. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Drug interactions: drug interactions between CCR5 antagonist and other drugs.