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Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection.
- Source :
-
The lancet. HIV [Lancet HIV] 2019 Mar; Vol. 6 (3), pp. e201-e204. - Publication Year :
- 2019
-
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.<br /> (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 2352-3018
- Volume :
- 6
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The lancet. HIV
- Publication Type :
- Academic Journal
- Accession number :
- 30846058
- Full Text :
- https://doi.org/10.1016/S2352-3018(19)30035-9