Patients receiving rifampicin-based anti-tuberculosis therapy are more likely to experience virological failure when starting nevirapine-based antiretroviral therapy, an HIV treatment that is widely used in developing countries because of lower cost, than when starting efavirenz-based antiretroviral therapy, according to a study in the August 6 issue of JAMA, a theme issue on HIV/AIDS.
Andrew Boulle, M.B.Ch.B., M.Sc., of the University of Cape Town, South Africa, presented the findings of the study at a JAMA media briefing on HIV/AIDS.
Combination antiretroviral therapy (ART) is frequently initiated in resource-limited countries when patients are being treated for tuberculosis. Co-administration of ART and anti-tubercular therapy may be complicated by shared toxicity or adverse drug interactions, according to background information in the article. Rifampicin-based anti-tubercular therapy reduces the plasma concentrations of the antiretroviral agents efavirenz and nevirapine. The virological consequences of these interactions are not well known.
Dr. Boulle and colleagues conducted a study to assess the effectiveness of efavirenz- or nevirapine-based combination ART used with rifampicin-based anti-tubercular therapy. The researchers analyzed clinical data collected from a community-based South African antiretroviral treatment program, in which adults were enrolled between May 2001 and June 2006 and were followed up until the end of 2006. The analysis included 2,035 individuals who started antiretroviral therapy with efavirenz (1,074 with tuberculosis) and 1,935 with nevirapine (209 with tuberculosis).