Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis
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 recommended | 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.
Page last reviewed: September 24, 2012