Pharmacological interactions between rifampicin and antiretroviral drugs: challenges and research priorities for resource-limited settings

Semvua, Hadija H.; Kibiki, Gibson S.; Kisanga, Elton R.; Boeree, Martin J.; Burger, David M.; Aarnoutse, Rob
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Co-administration of antituberculosis and antiretroviral therapy is often inevitable in high- burden countries where tuberculosis 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 sub-therapeutic 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 co-infected patients with NNRTI 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 maximising 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.