Pharmacokinetics of efavirenz in patients on antituberculosis treatment in high human immunodeficiency virus and tuberculosis burden countries: A systematic review.
Br J Clin Pharmacol
; 84(8): 1641-1658, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29624706
ABSTRACT
AIMS:
Efavirenz (EFV) and rifampicin-isoniazid (RH) are cornerstone drugs in human immunodeficiency virus (HIV)-tuberculosis (TB) coinfection treatment but with complex drug interactions, efficacy and safety challenges. We reviewed recent data on EFV and RH interaction in TB/HIV high-burden countries.METHODS:
We conducted a systematic review of studies conducted in the high TB/HIV-burden countries between 1990 and 2016 on EFV pharmacokinetics during RH coadministration in coinfected patients. Two reviewers conducted article screening and data collection.RESULTS:
Of 119 records retrieved, 22 were included (two conducted in children), reporting either EFV mid-dose or pre-dose concentrations. In 19 studies, median or mean concentrations of RH range between 1000 and 4000 ng ml-1 , the so-called therapeutic range. The proportion of patients with subtherapeutic concentration of RH ranged between 3.1 and 72.2%, in 12 studies including one conducted in children. The proportion of patients with supratherapeutic concentration ranged from 19.6 to 48.0% in six adult studies and one child study. Five of eight studies reported virological suppression >80%. The association between any grade hepatic and central nervous system adverse effects with EFV/RH interaction was demonstrated in two and three studies, respectively. The frequency of the CYP2B6 516G > T polymorphism ranged from 10 to 28% and was associated with higher plasma EFV concentrations, irrespective of ethnicity.CONCLUSIONS:
Anti-TB drug coadministration minimally affect the EFV exposure, efficacy and safety among TB-HIV coinfected African and Asian patients. This supports the current 600 mg EFV dosing when coadministered with anti-TB drugs.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Tuberculose
/
Infecções por HIV
/
Fármacos Anti-HIV
/
Coinfecção
/
Antituberculosos
Tipo de estudo:
Etiology_studies
/
Systematic_reviews
País/Região como assunto:
Africa
/
Asia
Idioma:
En
Revista:
Br J Clin Pharmacol
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Uganda