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13th Annual Conference of the British HIV Association29 March–1 April 2007, Brighton, UK |
PLASMA NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR (NNRTI) CONCENTRATIONS IN PATIENTS RECEIVING CONCOMITANT NNRTIs AND RIFAMPICIN (RIF)
HIV Med 2007; 8(Suppl. 1):13 (abstract no. P14)
Leena Sathia1, Ifeyinwa Obiorah1, Rosy Weston1, Sara Gibbons2, Graham Taylor3 and John Walsh1
1Jefferiss Wing, St Mary’s Hospital, London, UK, 2Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK, 3Division of Medicine, Imperial College and Jefferiss Wing, St Mary’s Hospital, London, UK
INTRODUCTION: Pharmacokinetic interactions between RIF and NNRTIs pose challenges in the treatment of TB/HIV co-infection. We describe NNRTI plasma concentrations (PC) and treatment outcomes in TB/HIV co-infected patients receiving RIF and NNRTIs concomitantly.
METHODS: In our department, data are prospectively collected on all TB/HIV coinfected patients. We assessed all patients who received concomitant NNRTIs and RIF between 2001 and 2005.
RESULTS: Of 103 TB/HIV co-infected patients, 43 received concomitant RIF with NNRTIs; 26 efavirenz (EFV) and 17 nevirapine (NVP). NNRTIs were commenced after RIF in 18/26 (69%) and 7/17 (41%) subjects on EFV and NVP respectively. 88% completed therapy, two (5%) deaths were observed and unrelated to TB and three (7%) were lost to follow-up or discontinued therapy. 83%, 11% and 6% of subjects had normal, G1-2 and G3-4 LFTs 4 months after starting concomitant therapy. 30/43 patients on NNRTI+RIF had PCs assessed. First PCs were within the therapeutic range in 5/7, 2/4, 3/6 and 7/13 patients on NVP 200 mg bid, NVP 300 mg bid, EFV 600 mg od and EFV 800 mg od respectively. PCs were sub-therapeutic in 4/11 (36%) and 3/19 (16%) subjects on NVP and EFV respectively with no virological rebounds observed. PCs were in the therapeutic range in three subjects on repeat testing and one subject after dose escalation to NVP 400 mg bid.
DISCUSSION: A total of 64% and 84% of subjects receiving concomitant NVP or EFV with RIF respectively had therapeutic PCs. Sub-therapeutic PCs, although frequent, were not associated with virological failure. A low incidence of hepatotoxicity and good clinical outcomes were observed.
2007-03-29
P14
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