Pharmacokinetic interaction between raltegravir and rifampicin in an infant with HIV exposed to active TB: a case report

Abstract

We report a case of an infant with HIV receiving raltegravir granules for oral suspension and rifampicin-based TB prophylaxis. Raltegravir trough levels remained subtherapeutic and viral load increased during concurrent rifampicin therapy despite using double-dosed raltegravir. Even after rifampicin therapy, a higher dose was needed. This highlights the importance of therapeutic drug monitoring and dose adjustments of raltegravir in infants with rifampicin as comedication.

Brief Report: Suboptimal Lopinavir Exposure in Infants on Rifampicin Treatment Receiving Double-dosed or Semisuperboosted Lopinavir/Ritonavir: Time for a Change

“…Double-dosed raltegravir was found to achieve pharmacokinetic targets safely in infants receiving concomitant rifampicin. 16 Yet, large interpatient pharmacokinetic variability of raltegravir and difficulties with the administration of oral granules could result in some infants being underdosed, 17 and availability of raltegravir in TB-endemic countries is limited. Adequacy of nevirapine dosing during rifampicin treatment is questionable, 18 and it is currently being phased-out for treatment of HIV across all ages.…”