title: Double-dose lopinavir-ritonavir in combination with rifampicin-based anti-tuberculosis treatment in South Africa.
abstract: BACKGROUND
  The optimal treatment for tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients in resource-poor settings receiving lopinavir-ritonavir (LPV/r) based second-line antiretroviral therapy (ART) has yet to be determined. In South Africa, clinicians are advised to use 'double-dose' LPV/r dosed at 800 mg/200 mg twice daily during anti-tuberculosis treatment.
  
  
  RESULTS
  We conducted a retrospective study of HIV-infected patients who received ≥2 months of double-dose LPV/r-based ART during concomitant rifampicin-containing anti-tuberculosis treatment. We used standard definitions for TB and HIV outcomes; virological failure was defined as a viral load >1000 copies/ml. During co-administration, gastro-intestinal toxicity occurred in 9/25 (36%) patients, a symptomatic rise in aspartate aminotransferase or alanine aminotransferase of any grade was noted in 3 (12%), with two Grade 3 events, and 3 (12%) patients required treatment discontinuation. Outcomes were favourable, with 20/25 (80%) patients achieving TB treatment success and virological failure observed among 3 (12%) patients during co-administration.
  
  
  CONCLUSIONS
  We found the use of double-dose LPV/r during simultaneous standard anti-tuberculosis treatment to be an effective and reasonably well tolerated interim strategy.
authors.affiliation: McCord Hospital, Durban, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Sunpath
authors.affiliation: St. Vincent Hospital, Indianapolis, Indiana, USA.
authors.forename: P
authors.initials: P
authors.lastname: Winternheimer
authors.affiliation: Department of Medicine New York University School of Medicine, New York, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.affiliation: University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: I
authors.initials: I
authors.lastname: Tennant
authors.affiliation: McCord Hospital, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Chelin
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA;;Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Gandhi
authors.affiliation: Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage* / Q000009:adverse effects; D060085:Coinfection; D004338:Drug Combinations; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D061466:Lopinavir / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage* / Q000009:adverse effects; D019438:Ritonavir / Q000008:administration & dosage* / Q000009:adverse effects; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D004338:Drug Combinations; D017320:HIV Protease Inhibitors; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D019438:Ritonavir; D012293:Rifampin