title: Pharmacological interactions between rifampicin and antiretroviral drugs: challenges and research priorities for resource-limited settings.
abstract: 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.
authors.affiliation: *Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; †University Centre for Chronic Diseases Dekkerswald, Radboud University Medical Centre, Nijmegen, the Netherlands; and ‡Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Hadija H
authors.initials: HH
authors.lastname: Semvua
authors.forename: Gibson S
authors.initials: GS
authors.lastname: Kibiki
authors.forename: Elton R
authors.initials: ER
authors.lastname: Kisanga
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Boeree
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.forename: Rob
authors.initials: R
authors.lastname: Aarnoutse
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004347:Drug Interactions; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D012293:Rifampin / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D012293:Rifampin