1. Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection.
- Author
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O'Donnell MR, Padayatchi N, Daftary A, Orrell C, Dooley KE, Rivet Amico K, and Friedland G
- Subjects
- Drug Substitution, Female, HIV Infections complications, Humans, Male, Medication Adherence, South Africa, Tuberculosis, Multidrug-Resistant complications, Anti-Retroviral Agents administration & dosage, Antitubercular Agents administration & dosage, Coinfection drug therapy, Diarylquinolines administration & dosage, HIV Infections drug therapy, Nevirapine administration & dosage, Tuberculosis, Multidrug-Resistant drug therapy
- 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., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
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