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Lancet HIV. 2019 Mar;6(3):e201-e204. doi: 10.1016/S2352-3018(19)30035-9.

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

Author information

1
Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA; CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa. Electronic address: mo2130@columbia.edu.
2
CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.
3
CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa; McGill International TB Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
4
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
5
Division of Clinical Pharmacology and Infectious Diseases, Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
6
School of Public Health, University of Michigan, Ann Arbor, MI, USA.
7
Yale School of Medicine, New Haven, CT, USA.

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.

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