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Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection.


ABSTRACT: Bedaquiline, a potent new therapy for drug-resistant tuberculosis, results in improved survival including in HIV patients with multidrug and extensively drug-resistant tuberculosis. In line with WHO recommendations, in South Africa and other low-income and middle-income settings, antiretroviral therapy is switched from generic fixed-dose combination efavirenz-containing regimens to twice-daily nevirapine with separate companion pills because of interactions between efavirenz and bedaquiline. Early data suggest a signal for low antiretroviral therapy adherence after this antiretroviral therapy switch. Mortality and other tuberculosis-specific benefits noted with bedaquiline treatment in multidrug and extensively drug-resistant tuberculosis HIV might be compromised by HIV viral failure, and emergent antiretroviral resistance. Programmatic responses, such as adherence support and dual pharmacovigilance, should be instituted; antiretroviral therapy initiation with fixed-dose combinations without bedaquiline drug interactions should be strongly considered.

SUBMITTER: O'Donnell MR 

PROVIDER: S-EPMC7155388 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection.

O'Donnell Max R MR   Padayatchi Nesri N   Daftary Amrita A   Orrell Catherine C   Dooley Kelly E KE   Rivet Amico K K   Friedland Gerald G  

The lancet. HIV 20190301 3


Bedaquiline, a potent new therapy for drug-resistant tuberculosis, results in improved survival including in HIV patients with multidrug and extensively drug-resistant tuberculosis. In line with WHO recommendations, in South Africa and other low-income and middle-income settings, antiretroviral therapy is switched from generic fixed-dose combination efavirenz-containing regimens to twice-daily nevirapine with separate companion pills because of interactions between efavirenz and bedaquiline. Ear  ...[more]

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