There is limited comparative data between efavirenz (EFV) 600 mg/day and nevirapine (NVP) 400 mg/day-based antiretroviral therapy (ART) among HIV-1 patients with tuberculosis (TB) and receiving rifampicin. MethodsA retrospective cohort study was conducted in all ART-naïve patients who were receiving rifampicin between January 2002 and December 2005. ResultsOf 188 patients, 77 and 111 patients were initiated on EFV-based ART (EFV group) and NVP-based ART (NVP group), respectively. Overall, median [interquartile range (IQR)] CD4 count was 36 (15-77) cells/mL and median (IQR) viral load was 5.6 (5.2-5.9) HIV-1 RNA log copies/mL. At 48 weeks, 77.9% (60/77) in the EFV group and 67.6% (75/111) in the NVP group achieved HIV-1 RNA o50 copies/mL (P 5 0.140, odds ratio 5 0.590, 95% confidence interval 5 0.302-1.153). At 24 and 48 weeks, respective median CD4 counts were 174 and 254 cells/mL in the EFV group and 156 and 218 cells/mL in the NVP group (P40.05). By binary logistic regression, treatment group was not associated with HIV-1 RNA o50 copies/mL (P40.05). No patient in the EFV group and eight (7.2%) patients in the NVP group discontinued ART because of adverse reactions (P 5 0.084). ConclusionsFor HIV-TB co-infected patients who receive rifampicin, efficacy of 600 mg EFV-based and 400 mg NVP-based ART may be similar, although adverse events tend to be higher in NVP-based ART.Keywords: efavirenz, HIV, nevirapine, standard dose, tuberculosis Received: 23 November 2007, accepted 1 February 2008 Introduction Tuberculosis (TB) and HIV-1 are the two leading causes of infectious disease-associated mortality worldwide. The accessibility of effective combined antiretroviral therapy (ART) has been associated with dramatic declines in the incidence of new AIDS cases and various opportunistic infections (OIs) among HIV-1-infected patients in many countries [1][2][3][4]. ART based on non-nucleoside reverse transcriptase inhibitors (NNRTIs) is a widely used regimen, particularly in resource-limited countries [5,6]. In most patients, CD4 cell counts rise with immune recovery after ART. Besides the appropriate timing of ART initiation, pill burdens, patients' adherence and overlapping toxicities, drug-drug interactions are also a major concern for treatment in HIV-1-infected patients with active TB [7]. To date, rifamycins are still the key drug class needed in the treatment of TB. Rifabutin is a weak cytochrome P450 enzyme inducer. Unfortunately, this drug is not available in many resource-limited countries, including Thailand. Therefore, rifampicin, a potent cytochrome P450 enzyme inducer, is still a key drug used for treatment of TB in these countries [8]. Moreover, current evidence shows clearly that relapse of TB in HIV-1-infected patients is minimized by a regimen containing rifampicin throughout the course of treatment [9]. DOI: 10.1111/j.1468-1293.2008.00563.x HIV Medicine (2008, 9, 294-299 r 2008 British HIV Association 294The drug-drug interactions of rifampicin and either NNRTIs or protease inhibitors (PIs) cause decre...

Nevirapine-based ART is an option for HIV-infected patients who receive rifampin in resource-limited countries or those who cannot tolerate efavirenz.

The aim of this study was to investigate safety and impact of temporary external lumbar drainage for continuous release of cerebrospinal fluid among patients with HIV-associated cryptococcal meningitis and elevated intracranial pressure (ICP). We conducted a retrospective cohort study among patients with cryptococcal meningitis in whom temporary external lumbar drains were placed to reduce intractable elevated ICP between January 2002 and December 2005. Patients were followed for three months after the procedure. Among 601 HIV-infected patients with cryptococcal meningitis, 54 (8.9%) underwent lumbar drain placement. Of these patients, mean age was 33 years and 80% were males. The median duration of an indwelling lumbar drain was seven days. There were 61 placement procedures among 54 patients, totalling to 473 device-days of observation. Overall incidence of secondary bacterial infections was 6.3 per 1000 device-days, and three (4.9%) of 61 catheters became secondarily infected with nosocomially acquired bacteria. All three drains were removed and appropriate antibiotics were given. There was no difference in median duration of placement between infected and uninfected drains (six days vs. seven days, P=0.572). The overall mortality rate was 5.6% in this cohort of 54 patients. In conclusion, the incidence of nosocomial infection of external lumbar drains is low. In resource-limited settings, the use of temporary external lumbar drainage is a safe and effective management strategy for intractable elevated ICP in HIV-infected patients with cryptococcal meningitis.