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

Max R. O'Donnell, Nesri Padayatchi, Amrita Daftary, Catherine Orrell, Kelly E. Dooley, K. Rivet Amico, Gerald Friedland

Research output: Contribution to journalComment/debatepeer-review

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.

Original languageEnglish (US)
Pages (from-to)e201-e204
JournalThe Lancet HIV
Volume6
Issue number3
DOIs
StatePublished - Mar 2019

ASJC Scopus subject areas

  • Epidemiology
  • Immunology
  • Infectious Diseases
  • Virology

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