Table 2 Therapeutic modifications that are required while administering rifamycins and ART concomitantly [103, 177]
From: Current trends and intricacies in the management of HIV-associated pulmonary tuberculosis
| Â | Rifampicin (dosage-600Â mg unless specified) interaction with ART modification and recommendation | Rifabutin (dosage-300Â mg unless specified) interaction with ART modification and recommendation |
|---|---|---|
Nucleoside reverse transcriptase inhibitors (NRTI’s) | No dose modification required Alternative regimens used only when NNRTI’s are contraindicated with VL < 100000copies/ml [103] Triple and quadruple NRTI regimens – caution to be exercised with triple regimen [178] | No dose modification required |
Non-nucleoside reverse transcriptase inhibitors (NNRTI’s) | ||
 Nevirapine | Not recommended routinely. If required., to avoid a lead in dose and start 200 mg BD [129] | No dose modification required as an alternative regimen with NVP |
 Efavirenz | Safe option, reduction only 20–25 % [183]. More dependent on CYP2B6 G516 G > T [184] Preferred with rifampicin | Increase rifabutin dosage to 450–600 mg, usually not recommended |
 Delavirdine | Not recommended | Not recommended |
 Etravarine | Reduction in NNRTI by 70–80 % [185]. Not recommended | Reduced by 35 % and Etravarine reduces rifabutin by 17 %. Same dose as rifabutin 300 mg [185] |
 Rilviprine | Reduction in NNRTI by 70–80 % [186]. Not recommended |  |
 Doravirine | Not recommended |  |
Protease inhibitors | ||
 Lopinavir/ritonavir | Not recommended | 150 mg daily |
 Saquinavir  All other PI’s [177]  Amprenavir Indinavir | Not recommended Increase Indinavir to 1000 mg thrice a day. | 300 mg daily 150 mg thrice weekly 150 mg daily |
Super boosting [51] | ||
 Lopinavir 400/ritonavir 400 | Super boosting not required for rifabutin | |
Double dosing [51] | ||
 Lopinavir 800 mg/ritonavir 200 mg | Double dosing not required for rifabutin | |
Integrase inhibitors | ||
Reduced by 60Â % [191] Increase dose of raltegravir to 800Â mg BD [193] Caution to be exercised in patients with higher VL | 400Â mg BD of raltegravir | |
 Dolutegravir [134] | Increase to 50 mg BD of dolutegravir | 25 mg BD of dolutegravir |
 Elvitagravir/cobicistat | Not recommended | Not recommended as reduced by 67 % [194] |
CCR5 Inhibitors | ||
 Maraviroc | Not recommended | Not recommended |