title: Antiretroviral treatment in HIV-infected children who require a rifamycin-containing regimen for tuberculosis.
abstract: In high prevalence settings, tuberculosis and HIV dual infection and co-treatment is frequent. Rifamycins, especially rifampicin, in combination with isoniazid, ethambutol and pyrazinamide are key components of short-course antituberculosis therapy. Areas covered: We reviewed available data, for which articles were identified by a Pubmed search, on rifamycin-antiretroviral interactions in HIV-infected children. Rifamycins have potent inducing effects on phase I and II drug metabolising enzymes and transporters. Antiretroviral medications are often metabolised by the enzymes induced by rifamycins or may suppress specific enzyme activity leading to drug-drug interactions with rifamycins. These may cause significant alterations in their phamacokinetic and pharmacodynamic properties, and sometimes that of the rifamycin. Recommended strategies to adapt to these interactions include avoidance and dose adjustment. Expert opinion: Despite the importance and frequency of tuberculosis as an opportunistic disease in HIV-infected children, current data on the management of co-treated children is based on few studies. We need new strategies to rapidly assess the use of rifamycins, new anti-tuberculosis drugs and antiretroviral drugs together as information on safety and dosing of individual drugs becomes available.
authors.affiliation: a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.|b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa.
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.affiliation: c Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Decloedt
authors.affiliation: d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Garcia-Prats
authors.affiliation: a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.|b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.affiliation: a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.|b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa.
authors.forename: Lisa
authors.initials: L
authors.lastname: Frigati
authors.affiliation: e Pediatric HIV Program , Drugs for Neglected Diseases Initiative , Geneva , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Lallemant
authors.affiliation: d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.
authors.forename: Anneke
authors.initials: A
authors.lastname: Hesseling
authors.affiliation: a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.|d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.
authors.forename: H Simon
authors.initials: HS
authors.lastname: Schaaf
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D012294:Rifamycins / Q000627:therapeutic use; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D012294:Rifamycins
keywords: Children; HIV; drug-drug interaction; rifamycin; tuberculosis