Use of Non-Nucleoside Analogues Together with Rifampin in HIV Patients with Tuberculosis

Villar, J. Pablo Sáez; Sánchez, Paquita; González, Alicia; Sorlí, Lluïsa; Montero, Milagro; Guelar, Ana; Solé, Emma; Lopez, J. Lopez; Knobel, Hernando

doi:10.1310/hct1203-171

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…One study adjusted EFV dose to weight [13], and two studies used NVP 400 mg once daily [14], [15]. Fifteen studies did not report NVP dosage, and were all assumed to use 200 mg twice daily as this is the standard recommended dosage [1].…”

Section: Resultsmentioning

confidence: 99%

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Outcomes for Efavirenz versus Nevirapine-Containing Regimens for Treatment of HIV-1 Infection: A Systematic Review and Meta-Analysis

et al. 2013

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IntroductionThere is conflicting evidence and practice regarding the use of the non-nucleoside reverse transcriptase inhibitors (NNRTI) efavirenz (EFV) and nevirapine (NVP) in first-line antiretroviral therapy (ART).MethodsWe systematically reviewed virological outcomes in HIV-1 infected, treatment-naive patients on regimens containing EFV versus NVP from randomised trials and observational cohort studies. Data sources include PubMed, Embase, the Cochrane Central Register of Controlled Trials and conference proceedings of the International AIDS Society, Conference on Retroviruses and Opportunistic Infections, between 1996 to May 2013. Relative risks (RR) and 95% confidence intervals were synthesized using random-effects meta-analysis. Heterogeneity was assessed using the I2 statistic, and subgroup analyses performed to assess the potential influence of study design, duration of follow up, location, and tuberculosis treatment. Sensitivity analyses explored the potential influence of different dosages of NVP and different viral load thresholds.ResultsOf 5011 citations retrieved, 38 reports of studies comprising 114 391 patients were included for review. EFV was significantly less likely than NVP to lead to virologic failure in both trials (RR 0.85 [0.73–0.99] I2 = 0%) and observational studies (RR 0.65 [0.59–0.71] I2 = 54%). EFV was more likely to achieve virologic success than NVP, though marginally significant, in both randomised controlled trials (RR 1.04 [1.00–1.08] I2 = 0%) and observational studies (RR 1.06 [1.00–1.12] I2 = 68%).ConclusionEFV-based first line ART is significantly less likely to lead to virologic failure compared to NVP-based ART. This finding supports the use of EFV as the preferred NNRTI in first-line treatment regimen for HIV treatment, particularly in resource limited settings.

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Section: Resultsmentioning

confidence: 99%

“…Six studies were done exclusively in TB/HIV co-infected patients [13], [20], [21], [22], [23], [24]. Another study included 188 patients on EFV and 86 patients on NVP who were co-infected with TB [25] while 36.1% of the IeDEA cohort [17] and 6.7% of the Kheth’Impilo cohort [26] were TB co-infected.…”

Section: Resultsmentioning

confidence: 99%

Outcomes for Efavirenz versus Nevirapine-Containing Regimens for Treatment of HIV-1 Infection: A Systematic Review and Meta-Analysis

et al. 2013

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“…28 Our data support recommendations advocating efavirenz at 600 mg/day for co-administration with rifampicin, but efavirenz at 800 mg/day remains an option for patients weighing .60 kg, 3,4 who tend to have lower efavirenz concentrations. 29 A higher risk of treatment failure was found when the efavirenz dose was not adjusted to body weight, 30 but the recent STRIDE study showed no benefit of weight-based dosing. 31 The tenofovir DF/emtricitabine and efavirenz combination tested here, although associated with a high rate of well-known adverse effects (partially due to close observation in the hospital setting), appears to be an acceptable option.…”

Section: Discussionmentioning

confidence: 99%

Tenofovir DF/emtricitabine and efavirenz combination therapy for HIV infection in patients treated for tuberculosis: the ANRS 129 BKVIR trial

Lortholary

Roussillon

Boucherie

et al. 2015

J. Antimicrob. Chemother.

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“…37 Most pharmacokinetic studies have shown that exposure to efavirenz is decreased upon coadministration of rifampicin, but whether to increase the dose of efavirenz when concomitantly used with rifampicin is still a subject of controversy. [44][45][46] Many of the studies have shown that response to standard-dose efavirenz based ART is similar in patients with and without rifampicin-containing treatment. 10 Also, a retrospective analysis of a therapeutic drug monitoring database found that efavirenz concentrations were significantly lowered (35%) with rifampicin.…”

Section: Interactions Between Rifampicin and Nnrtismentioning

confidence: 99%

Pharmacological Interactions Between Rifampicin and Antiretroviral Drugs

Semvua

Kibiki

Kisanga

et al. 2015

Therapeutic Drug Monitoring

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Coadministration of antituberculosis and antiretroviral therapy is often inevitable in high-burden countries where tuberculosis (TB) is the most common opportunistic infection associated with HIV/AIDS. Concurrent use of rifampicin and many antiretroviral drugs is complicated by pharmacokinetic drug-drug interactions. Rifampicin is a very potent enzyme inducer, which can result in subtherapeutic antiretroviral drug concentrations. In addition, TB drugs and antiretroviral drugs have additive (pharmacodynamic) interactions as reflected in overlapping adverse effect profiles. This review provides an overview of the pharmacological interactions between rifampicin-based TB treatment and antiretroviral drugs in adults living in resource-limited settings. Major progress has been made to evaluate the interactions between TB drugs and antiretroviral therapy; however, burning questions remain concerning nevirapine and efavirenz effectiveness during rifampicin-based TB treatment, treatment options for TB-HIV-coinfected patients with nonnucleoside reverse transcriptase inhibitor resistance or intolerance, and exact treatment or dosing schedules for vulnerable patients including children and pregnant women. The current research priorities can be addressed by maximizing the use of already existing data, creating new data by conducting clinical trials and prospective observational studies and to engage a lobby to make currently unavailable drugs available to those most in need.

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Use of Non-Nucleoside Analogues Together with Rifampin in HIV Patients with Tuberculosis

Abstract: The effectiveness of NVP and nonadjusted EFV was lower than adjusted EFV-based ART. It may be advisable to increase the dose of EFV to 800 mg once daily when administered with rifampin in patients weighing >60 kg.

Cited by 5 publications

References 12 publications

Outcomes for Efavirenz versus Nevirapine-Containing Regimens for Treatment of HIV-1 Infection: A Systematic Review and Meta-Analysis

Outcomes for Efavirenz versus Nevirapine-Containing Regimens for Treatment of HIV-1 Infection: A Systematic Review and Meta-Analysis

Tenofovir DF/emtricitabine and efavirenz combination therapy for HIV infection in patients treated for tuberculosis: the ANRS 129 BKVIR trial

Pharmacological Interactions Between Rifampicin and Antiretroviral Drugs

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