Antiretroviral treatment in HIV-infected children who require a rifamycin-containing regimen for tuberculosis

Expert Opin Pharmacother. 2017 Apr;18(6):589-598. doi: 10.1080/14656566.2017.1309023. Epub 2017 Mar 27.

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.

Keywords: Children; HIV; drug-drug interaction; rifamycin; tuberculosis.

Publication types

  • Review

MeSH terms

  • Anti-HIV Agents / therapeutic use*
  • Antitubercular Agents / therapeutic use
  • Child
  • Drug Interactions
  • HIV Infections / drug therapy*
  • Humans
  • Rifamycins / therapeutic use
  • Tuberculosis / drug therapy*

Substances

  • Anti-HIV Agents
  • Antitubercular Agents
  • Rifamycins