Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: O'Donnell, Max R; Padayatchi, Nesri; Daftary, Amrita; Orrell, Catherine; Dooley, Kelly E; Rivet Amico, K; Friedland, Gerald
• Is Part Of: Lancet. Volume 6:Issue 3(2019)
• Page Start: e201
• Page End: e204
• Publication Date: 2019-03
• Subjects: HIV (Viruses) -- Periodicals; HIV infections -- Periodicals; AIDS (Disease) -- Periodicals; 616.9792
• DOI: 10.1016/S2352-3018(19)30035-9
• Languages: English
• ISSNs: 2405-4704

Abstract

Summary: 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.