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Managing Drug Interactions in the
Treatment of HIV-Related
Tuberculosis
The Role of Rifamycins in
Tuberculosis Treatment
Despite the complexity of these drug interactions,
the key role of the rifamycins in the success of tuberculosis treatment mandates
that the drug-drug interactions between the rifamycins and antiretroviral drugs
be managed, not avoided by using tuberculosis treatment regimens that do not
include a rifamycin or by withholding antiretroviral therapy until completion
of anti-tuberculosis therapy among patients with advanced immunodeficiency.
In randomized trials, regimens without rifampin or in which rifampin was only
used for the first two months of therapy resulted in higher rates of tuberculosis
treatment failure and relapse 5, 6. The sub-optimal performance
of the regimen of two months of rifampin (with isoniazid, pyrazinamide, and
ethambutol) followed by 6 months of isoniazid + ethambutol was particularly
notable among participants with HIV co-infection 5. Therefore, patients
with HIV-related tuberculosis should be treated with a regimen including a rifamycin
for the full course of tuberculosis treatment, unless the isolate is resistant
to the rifamycins or the patient has a severe side effect that is clearly due
to the rifamycins.
Furthermore, patients with advanced HIV disease (CD4
cell count < 100 cells/mm3) have an increased risk of acquired
rifamycin resistance if treated with a rifamycin-containing regimen administered
once or twice-weekly 1, 7. The rifamycin-based regimen should be
administered daily (5-7 days per week) for at least the first 2 months of treatment
among patients with advanced HIV disease 8, 9.
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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