title: Initiating antiretrovirals during tuberculosis treatment: a drug safety review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of KwaZulu-Natal, Centre for the AIDS Programme of Research in South Africa, 719 Umbilo Rd, Durban, 4013, South Africa. gengiaht1@ukzn.ac.za
authors.forename: Tanuja N
authors.initials: TN
authors.lastname: Gengiah
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Gray
authors.forename: Kogieleum
authors.initials: K
authors.lastname: Naidoo
authors.forename: Quarraisha Abdool
authors.initials: QA
authors.lastname: Karim
mesh_terms: D000818:Animals; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004347:Drug Interactions / Q000502:physiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000139:chemically induced / Q000378:metabolism; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents