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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

  Rifampicin (dosage-600 mg unless specified) interaction with ART modification and recommendation Rifabutin (dosage-300 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 Reduced by 55 % [179182]
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]
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 Not recommended due to toxicity [187190] Super boosting not required for rifabutin
Double dosing [51]
 Lopinavir 800 mg/ritonavir 200 mg Not recommended due to toxicity [187190] Double dosing not required for rifabutin
Integrase inhibitors
 Raltegravir [192, 193] Reduced by 60 % [191]
Increase dose of raltegravir to 800 mg BD [193]
Caution to be exercised in patients with higher VL
400 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
  1. CYP cytochrome P450