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Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis

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Table 1b. Recommendations for regimens for the concomitant treatment of tuberculosis and HIV infection in children

Combined regimen for treatment of HIV and tuberculosis

PK effect of the rifamycin

Tolerability / toxicity

Antiviral activity when used with rifampin

Recommendation
(comments)

Super-boosted lopinavir-ritonavir‡ based ART with rifampin-containing tuberculosis treatment

Modest effect

Hepatitis

Early favorable experience of super-boosting among young children

Double dose lopinavir-ritonavir is not recommended

Efavirenz-based ART with rifampin-containing tuberculosis treatment

Well-characterized, modest effect

Low rates of discontinuation

Limited study; careful  virologic monitoring recommmended

Alternative for children >3 years (and >10 kg) for whom super-boosted lopinavir/ritonavir is not tolerated or is contraindicated.

Zidovudine / lamivudine / abacavir  with rifampin-containing tuberculosis treatment

50% decrease in zidovudine, possible effect on abacavir not evaluated

Anemia

Early favorable experience, but this combination is less effective than efavirenz- or nevirapine-based regimens in adults not taking rifampin

Alternative for children <3 years or for patients for whom super- boosted lopinavir/ritonavir is not tolerated or is contraindicated

 

‡ Super-boosting of lopinavir in children is achieved by giving standard-dose lopinavir/ritonavir plus additional ritonavir to achieve mg for mg parity of ritonavir and lopinavir. 

 

 
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