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Semere Gebreyesus M, Wasmann RE, McIlleron H, Oladokun R, Okonkwo P, Wiesner L, Denti P, Rawizza HE. Population pharmacokinetics of rifabutin among HIV/TB co-infected children on lopinavir/ritonavir-based antiretroviral therapy. Antimicrob Agents Chemother 2024; 68:e0035424. [PMID: 39037240 PMCID: PMC11304744 DOI: 10.1128/aac.00354-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
In adults requiring protease inhibitor (PI)-based antiretroviral therapy (ART), replacing rifampicin with rifabutin is a preferred option, but there is lack of evidence to guide rifabutin dosing in children, especially with PIs. We aimed to characterize the population pharmacokinetics of rifabutin and 25-O-desacetyl rifabutin (des-rifabutin) in children and optimize its dose. We included children from three age cohorts: (i) <1-year-old cohort and (ii) 1- to 3-year-old cohort, who were ART naïve and received 15- to 20-mg/kg/day rifabutin for 2 weeks followed by lopinavir/ritonavir (LPV/r)-based ART with 5.0- or 2.5 mg/kg/day rifabutin, respectively, while the (iii) >3-year-old cohort was ART-experienced and received 2.5-mg/kg/day rifabutin with LPV/r-based ART. Non-linear mixed-effects modeling was used to interpret the data. Monte Carlo simulations were performed to evaluate the study doses and optimize dosing using harmonized weight bands. Twenty-eight children were included, with a median age of 10 (range 0.67-15.0) years, a median weight of 11 (range 4.5-45) kg, and a median weight-for-age z score of -3.33 (range -5.15 to -1.32). A two-compartment disposition model, scaled allometrically by weight, was developed for rifabutin and des-rifabutin. LPV/r increased rifabutin bioavailability by 158% (95% confidence interval: 93.2%-246.0%) and reduced des-rifabutin clearance by 76.6% (74.4%-78.3%). Severely underweight children showed 26% (17.9%-33.7%) lower bioavailability. Compared to adult exposures, simulations resulted in higher median steady-state rifabutin and des-rifabutin exposures in 6-20 kg during tuberculosis-only treatment with 20 mg/kg/day. During LPV/r co-treatment, the 2.5-mg/kg/day dose achieved similar exposures to adults, while the 5-mg/kg/day dose resulted in higher exposures in children >7 kg. All study doses maintained a median Cmax of <900 µg/L. The suggested weight-band dosing matches adult exposures consistently across weights and simplifies dosing.
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Affiliation(s)
- Manna Semere Gebreyesus
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland E. Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Regina Oladokun
- Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Holly E. Rawizza
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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2
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Wasserman S, Antilus-Sainte R, Abdelgawad N, Odjourian NM, Cristaldo M, Dougher M, Kaya F, Zimmerman M, Denti P, Gengenbacher M. Rifabutin central nervous system concentrations in a rabbit model of tuberculous meningitis. Antimicrob Agents Chemother 2024; 68:e0078324. [PMID: 39028192 PMCID: PMC11304741 DOI: 10.1128/aac.00783-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
Tuberculous meningitis (TBM) has a high mortality, possibly due to suboptimal therapy. Drug exposure data of antituberculosis agents in the central nervous system (CNS) are required to develop more effective regimens. Rifabutin is a rifamycin equivalently potent to rifampin in human pulmonary tuberculosis. Here, we show that human-equivalent doses of rifabutin achieved potentially therapeutic exposure in relevant CNS tissues in a rabbit model of TBM, supporting further evaluation in clinical trials.
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Affiliation(s)
- Sean Wasserman
- Institute for Infection and Immunity, St. George’s, University of London, London, United Kingdom
- Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Noha Abdelgawad
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Narineh M. Odjourian
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Melissa Cristaldo
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Maureen Dougher
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Firat Kaya
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Matthew Zimmerman
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Martin Gengenbacher
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
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3
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Shiri Aghbash P, Ebrahimzadeh Leylabadlo H, Fathi H, Bahmani M, Chegini R, Bannazadeh Baghi H. Hepatic Disorders and COVID-19: From Pathophysiology to Treatment Strategy. Can J Gastroenterol Hepatol 2022; 2022:4291758. [PMID: 36531832 PMCID: PMC9754839 DOI: 10.1155/2022/4291758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022] Open
Abstract
Following the SARS-CoV-2 outbreak and the subsequent development of the COVID-19 pandemic, organs such as the lungs, kidneys, liver, heart, and brain have been identified as priority organs. Liver diseases are considered a risk factor for high mortality from the COVID-19 pandemic. Besides, liver damage has been demonstrated in a substantial proportion of patients with COVID-19, especially those with severe clinical symptoms. Furthermore, antiviral medications, immunosuppressive drugs after liver transplantation, pre-existing hepatic diseases, and chronic liver diseases such as cirrhosis have also been implicated in SARS-CoV-2-induced liver injury. As a result, some precautions have been taken to prevent, monitor the virus, and avoid immunocompromised and susceptible individuals, such as liver and kidney transplant recipients, from being infected with SARS-CoV-2, thereby avoiding an increase in mortality. The purpose of this review was to examine the impairment caused by SARS-CoV-2 infection and the impact of drugs used during the pandemic on the mortality range and therefore the possibility of preventive measures in patients with liver disease.
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Affiliation(s)
- Parisa Shiri Aghbash
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hamidreza Fathi
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz, Iran
| | - Mohaddeseh Bahmani
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rojin Chegini
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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4
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Gastrointestinal Ischemia—Stumbling Stone in COVID-19 Patients. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal (GI) disorders, especially ischemic damage. Inflammation, vasculopathy, immobility, endothelial dysfunction, and a hypercoagulable condition have all been proposed as pathophysiological factors for GI ischemia in these patients. Owing to the COVID-19 effect on a variety of GI conditions, especially ischemic changes, and the high mortality rate, physicians should always keep in mind this complication. They should take a deeper look at clinical and imaging modalities in this cohort of patients so that a proper and time-saving treatment strategy can be applied. Our study aimed to elucidate the thrombogenic mechanism in different GI disorders. Moreover, we analyzed the factors related to necrotic GI changes, by summarizing the already reported data of GI ischemia in COVID-19. To the best of our knowledge, this review is the first to incorporate all GI ischemia cases reported in the literature so far.
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5
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Zuo G, Liu W. The clinical characteristics and underlying causes of liver damage in patients with COVID-19 infection: Retrospective analysis. Pak J Med Sci 2021; 37:1282-1287. [PMID: 34475899 PMCID: PMC8377893 DOI: 10.12669/pjms.37.5.4161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives 2019-nCoV has become a global threat to human health. The primary objective of this study was to examine the hepatic damage in 2019-nCoV infected patients and the associated underlying causes. Methods In this retrospective study, a total of 68 laboratory-confirmed and 20 suspected COVID-19 cases from 23rd January 2020 to 15th February 2020 were included. The study was conducted in The First People's Hospital of Jingzhou, Hubei. SPSS version 23.0. was used for Statistical analysis using the Student's t-test or Chi-square test. Data was analyzed for the clinical characteristics and underlying causes of liver damage. The outcomes were followed up until March 29, 2020. Results Out of the 68 COVID-19 confirmed cases, 51 had an abnormal liver function, of which 15 had an abnormal liver function at the time of hospital admission. The relationship between the liver function and clinical prognosis of patients showed that the abnormal liver function was positively correlated with the severity of the infection (100% vs.70.2%, p=0.036). The proportion of patients with an elevated level of ALT and a depleted level of Albumin (ALB) were significantly lower in the COVID-19 suspected group than the confirmed group (5% vs. 50.9%, p=0.000; 10% vs. 35.8%, p=0.030, respectively). Besides, the utilization rate of lopinavir/ritonavir, azithromycin, and methylprednisolone in COVID-19 suspected patients were significantly lower than the confirmed patients (25% vs. 62.3%, p=0.004; 35% vs. 62.3%, p=0.037; 25% vs. 64.2%, p=0.003, respectively). Conclusions Liver function anomalies are one of the common symptoms associated with the COVID-19 infection, where virus-replication in the liver cells, virus-induced inflammatory response, and administration of clinical medication could be the plausible reason.
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Affiliation(s)
- Guojin Zuo
- Guojin Zuo, Department of Ophthalmology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, 434000, China
| | - Weirong Liu
- Weirong Liu Department of Pathology, Yangtze University Health Science Center, Jingzhou, Hubei, 434023, China
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6
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Zhou F, Xia J, Yuan HX, Sun Y, Zhang Y. Liver injury in COVID-19: Known and unknown. World J Clin Cases 2021; 9:4980-4989. [PMID: 34307548 PMCID: PMC8283595 DOI: 10.12998/wjcc.v9.i19.4980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/13/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Since the first report of the coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China, the outbreak of the disease is currently continuously evolving. Previous studies have shown varying degrees of liver damage in patients with COVID-19. However, the exact causes of liver injury and the relationship between COVID-19 and liver injury is unclear. This article describes liver injury induced by COVID-19, analyzes its causes, and discusses the treatment and prognosis of liver damage in patients with COVID-19.
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Affiliation(s)
- Feng Zhou
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Jian Xia
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Hai-Xia Yuan
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Sun
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
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7
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McGrowder DA, Miller F, Anderson Cross M, Anderson-Jackson L, Bryan S, Dilworth L. Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis. Diseases 2021; 9:diseases9030050. [PMID: 34287285 PMCID: PMC8293258 DOI: 10.3390/diseases9030050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, millions of persons have contracted the coronavirus disease 2019 (COVID-19) over the past several months, resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.
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Affiliation(s)
- Donovan A. McGrowder
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
- Correspondence:
| | - Fabian Miller
- Department of Physical Education, Faculty of Education, The Mico University College, 1A Marescaux Road, Kingston 5, Jamaica;
- Department of Biotechnology, Faculty of Science and Technology, The University of the West Indies, Kingston 7, Jamaica
| | - Melisa Anderson Cross
- School of Allied Health and Wellness, College of Health Sciences, University of Technology, Kingston 7, Jamaica;
| | - Lennox Anderson-Jackson
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
| | - Sophia Bryan
- Department of Basic Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica;
| | - Lowell Dilworth
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
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8
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Rawizza HE, Oladokun R, Ejeliogu E, Oguche S, Ogunbosi BO, Agbaji O, Odaibo G, Imade G, Olaleye D, Wiesner L, Darin KM, Okonkwo P, Kanki PJ, Scarsi KK, McIlleron HM. Rifabutin pharmacokinetics and safety among TB/HIV-coinfected children receiving lopinavir/ritonavir-containing second-line ART. J Antimicrob Chemother 2021; 76:710-717. [PMID: 33294914 PMCID: PMC7879135 DOI: 10.1093/jac/dkaa512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Treatment options are limited for TB/HIV-coinfected children who require PI-based ART. Rifabutin is the preferred rifamycin for adults on PIs, but the one study evaluating rifabutin with PIs among children was stopped early due to severe neutropenia. METHODS We evaluated rifabutin safety and plasma pharmacokinetics among coinfected children 3-15 years of age receiving rifabutin 2.5 mg/kg daily with standard doses of lopinavir/ritonavir. The AUC0-24 at 2, 4 and 8 weeks after rifabutin initiation was described using intensive sampling and non-compartmental analysis. Clinical and laboratory toxicities were intensively monitored at 12 visits throughout the study. RESULTS Among 15 children with median (IQR) age 13.1 (10.9-14.0) years and weight 25.5 (22.3-30.5) kg, the median (IQR) rifabutin AUC0-24 was 5.21 (4.38-6.60) μg·h/mL. Four participants had AUC0-24 below 3.8 μg·h/mL (a target for the population average exposure) at week 2 and all had AUC0-24 higher than 3.8 μg·h/mL at the 4 and 8 week visits. Of 506 laboratory evaluations during rifabutin, grade 3 and grade 4 abnormalities occurred in 16 (3%) and 2 (0.4%) instances, respectively, involving 9 (60%) children. Specifically, grade 3 (n = 4) and grade 4 (n = 1) neutropenia resolved without treatment interruption or clinical sequelae in all patients. One child died at week 4 of HIV-related complications. CONCLUSIONS In children, rifabutin 2.5 mg/kg daily achieved AUC0-24 comparable to adults and favourable HIV and TB treatment outcomes were observed. Severe neutropenia was relatively uncommon and improved with ongoing rifabutin therapy. These data support the use of rifabutin for TB/HIV-coinfected children who require lopinavir/ritonavir.
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Affiliation(s)
- Holly E Rawizza
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina Oladokun
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Emeka Ejeliogu
- College of Health Sciences, Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Stephen Oguche
- College of Health Sciences, Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Babatunde O Ogunbosi
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Oche Agbaji
- College of Health Sciences, Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Georgina Odaibo
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Godwin Imade
- College of Health Sciences, Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - David Olaleye
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kristin M Darin
- Northwestern University School of Professional Studies, Chicago, IL, USA
| | | | | | - Kimberly K Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Helen M McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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9
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Jacobs TG, Svensson EM, Musiime V, Rojo P, Dooley KE, McIlleron H, Aarnoutse RE, Burger DM, Turkova A, Colbers A. Pharmacokinetics of antiretroviral and tuberculosis drugs in children with HIV/TB co-infection: a systematic review. J Antimicrob Chemother 2020; 75:3433-3457. [PMID: 32785712 PMCID: PMC7662174 DOI: 10.1093/jac/dkaa328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/29/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Management of concomitant use of ART and TB drugs is difficult because of the many drug-drug interactions (DDIs) between the medications. This systematic review provides an overview of the current state of knowledge about the pharmacokinetics (PK) of ART and TB treatment in children with HIV/TB co-infection, and identifies knowledge gaps. METHODS We searched Embase and PubMed, and systematically searched abstract books of relevant conferences, following PRISMA guidelines. Studies not reporting PK parameters, investigating medicines that are not available any longer or not including children with HIV/TB co-infection were excluded. All studies were assessed for quality. RESULTS In total, 47 studies met the inclusion criteria. No dose adjustments are necessary for efavirenz during concomitant first-line TB treatment use, but intersubject PK variability was high, especially in children <3 years of age. Super-boosted lopinavir/ritonavir (ratio 1:1) resulted in adequate lopinavir trough concentrations during rifampicin co-administration. Double-dosed raltegravir can be given with rifampicin in children >4 weeks old as well as twice-daily dolutegravir (instead of once daily) in children older than 6 years. Exposure to some TB drugs (ethambutol and rifampicin) was reduced in the setting of HIV infection, regardless of ART use. Only limited PK data of second-line TB drugs with ART in children who are HIV infected have been published. CONCLUSIONS Whereas integrase inhibitors seem favourable in older children, there are limited options for ART in young children (<3 years) receiving rifampicin-based TB therapy. The PK of TB drugs in HIV-infected children warrants further research.
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Affiliation(s)
- Tom G Jacobs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
| | - Elin M Svensson
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Victor Musiime
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit. Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rob E Aarnoutse
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
| | - David M Burger
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
| | - Anna Turkova
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Angela Colbers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
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Phillips MC, Wald-Dickler N, Loomis K, Luna BM, Spellberg B. Pharmacology, Dosing, and Side Effects of Rifabutin as a Possible Therapy for Antibiotic-Resistant Acinetobacter Infections. Open Forum Infect Dis 2020; 7:ofaa460. [PMID: 33204754 PMCID: PMC7651144 DOI: 10.1093/ofid/ofaa460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
Acinetobacter baumannii has among the highest rates of antibiotic resistance encountered in hospitals. New therapies are critically needed. We found that rifabutin has previously unrecognized hyperactivity against most strains of A. baumannii. Here we review the pharmacology and adverse effects of rifabutin to inform potential oral dosing strategies in patients with A. baumannii infections. Rifabutin demonstrates dose-dependent increases in blood levels up to 900 mg per day, but plateaus thereafter. Furthermore, rifabutin induces its own metabolism after prolonged dosing, lowering its blood levels. Pending future development of an intravenous formulation, a rifabutin oral dose of 900-1200 mg per day for 1 week is a rational choice for adjunctive therapy of A. baumannii infections. This dosage maximizes AUC24 to drive efficacy while simultaneously minimizing toxicity. Randomized controlled trials will be needed to definitively establish the safety and efficacy of rifabutin to treat A. baumannii infections.
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Affiliation(s)
- Matthew C Phillips
- Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Noah Wald-Dickler
- Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.,Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Katherine Loomis
- Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Brian M Luna
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brad Spellberg
- Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
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11
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Ong CWM, Migliori GB, Raviglione M, MacGregor-Skinner G, Sotgiu G, Alffenaar JW, Tiberi S, Adlhoch C, Alonzi T, Archuleta S, Brusin S, Cambau E, Capobianchi MR, Castilletti C, Centis R, Cirillo DM, D'Ambrosio L, Delogu G, Esposito SMR, Figueroa J, Friedland JS, Ho BCH, Ippolito G, Jankovic M, Kim HY, Rosales Klintz S, Ködmön C, Lalle E, Leo YS, Leung CC, Märtson AG, Melazzini MG, Najafi Fard S, Penttinen P, Petrone L, Petruccioli E, Pontali E, Saderi L, Santin M, Spanevello A, van Crevel R, van der Werf MJ, Visca D, Viveiros M, Zellweger JP, Zumla A, Goletti D. Epidemic and pandemic viral infections: impact on tuberculosis and the lung: A consensus by the World Association for Infectious Diseases and Immunological Disorders (WAidid), Global Tuberculosis Network (GTN), and members of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC). Eur Respir J 2020; 56:2001727. [PMID: 32586885 PMCID: PMC7527651 DOI: 10.1183/13993003.01727-2020] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Abstract
Major epidemics, including some that qualify as pandemics, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), HIV, influenza A (H1N1)pdm/09 and most recently COVID-19, affect the lung. Tuberculosis (TB) remains the top infectious disease killer, but apart from syndemic TB/HIV little is known regarding the interaction of viral epidemics and pandemics with TB. The aim of this consensus-based document is to describe the effects of viral infections resulting in epidemics and pandemics that affect the lung (MERS, SARS, HIV, influenza A (H1N1)pdm/09 and COVID-19) and their interactions with TB. A search of the scientific literature was performed. A writing committee of international experts including the European Centre for Disease Prevention and Control Public Health Emergency (ECDC PHE) team, the World Association for Infectious Diseases and Immunological Disorders (WAidid), the Global Tuberculosis Network (GTN), and members of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC) was established. Consensus was achieved after multiple rounds of revisions between the writing committee and a larger expert group. A Delphi process involving the core group of authors (excluding the ECDC PHE team) identified the areas requiring review/consensus, followed by a second round to refine the definitive consensus elements. The epidemiology and immunology of these viral infections and their interactions with TB are discussed with implications for diagnosis, treatment and prevention of airborne infections (infection control, viral containment and workplace safety). This consensus document represents a rapid and comprehensive summary on what is known on the topic.
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Affiliation(s)
- Catherine Wei Min Ong
- Dept of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
- These authors contributed equally
- Members of ESGMYC
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
- These authors contributed equally
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
- Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Members of ESGMYC
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
- Members of ESGMYC
| | - Cornelia Adlhoch
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Tonino Alonzi
- Translational Research Unit, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Sophia Archuleta
- Dept of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sergio Brusin
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Emmanuelle Cambau
- AP-HP-Lariboisiere, Bacteriologie, Laboratory Associated to the National Reference Centre for Mycobacteria, IAME UMR1137, INSERM, University of Paris, Paris, France
- Members of ESGMYC
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Daniela M Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Members of ESGMYC
| | | | - Giovanni Delogu
- Università Cattolica Sacro Cuore, Roma, Italy
- Mater Olbia Hospital, Olbia, Italy
- Members of ESGMYC
| | - Susanna M R Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | | - Jon S Friedland
- St George's, University of London, London, UK
- Members of ESGMYC
| | - Benjamin Choon Heng Ho
- Tuberculosis Control Unit, Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Giuseppe Ippolito
- Scientific Direction, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Mateja Jankovic
- School of Medicine, University of Zagreb and Clinic for Respiratory Diseases, University Hospital Center Zagreb, Zagreb, Croatia
- Members of ESGMYC
| | - Hannah Yejin Kim
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
- Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Senia Rosales Klintz
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Csaba Ködmön
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Eleonora Lalle
- Laboratory of Virology, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
| | - Chi-Chiu Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Wanchai, Hong Kong, China
| | - Anne-Grete Märtson
- Dept of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Saeid Najafi Fard
- Translational Research Unit, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Pasi Penttinen
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Linda Petrone
- Translational Research Unit, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Elisa Petruccioli
- Translational Research Unit, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | | | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Miguel Santin
- Dept of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Dept of Clinical Science, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Members of ESGMYC
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Reinout van Crevel
- Radboudumc Center for Infectious Diseases, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
- Members of ESGMYC
| | - Marieke J van der Werf
- Public Health Emergency Team, European Centre for Disease Prevention and Control, Stockholm, Sweden
- European Centre for Disease Prevention and Control Public Health Emergency team co-authors
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Miguel Viveiros
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Members of ESGMYC
| | | | - Alimuddin Zumla
- Dept of Infection, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Delia Goletti
- Translational Research Unit, Epidemiology and Preclinical Research Dept, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
- Members of ESGMYC
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12
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Wu Y, Li H, Guo X, Yoshida EM, Mendez-Sanchez N, Levi Sandri GB, Teschke R, Romeiro FG, Shukla A, Qi X. Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. Hepatol Int 2020; 14:621-637. [PMID: 32710250 PMCID: PMC7380163 DOI: 10.1007/s12072-020-10074-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. METHODS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. RESULTS Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). CONCLUSIONS Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients.
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Affiliation(s)
- Yanyan Wu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Hongyu Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
| | - Eric M. Yoshida
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | - Nahum Mendez-Sanchez
- Liver Research Unit Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Germany
| | | | - Akash Shukla
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Parel, Mumbai India
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
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13
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Rawizza HE, Darin KM, Oladokun R, Brown B, Ogunbosi B, David N, Akanmu S, Olaitan O, Chang C, Scarsi KK, Okonkwo P, Kanki PJ. Safety and efficacy of rifabutin among HIV/TB-coinfected children on lopinavir/ritonavir-based ART. J Antimicrob Chemother 2020; 74:2707-2715. [PMID: 31139825 DOI: 10.1093/jac/dkz219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND TB is the leading cause of death among HIV-infected children, yet treatment options for those who require PI-based ART are suboptimal. Rifabutin is the preferred rifamycin for adults on PI-based ART; only one study has evaluated its use among children on PIs and two of six children developed treatment-limiting neutropenia. METHODS Since 2009, rifabutin has been available for HIV/TB-coinfected children requiring PI-based ART in the Harvard/APIN programme in Nigeria. We retrospectively analysed laboratory and clinical toxicities at baseline and during rifabutin therapy, and examined HIV/TB outcomes. RESULTS Between 2009 and 2015, 48 children received rifabutin-containing TB therapy with PI (lopinavir/ritonavir)-based ART: 50% were female with a median (IQR) baseline age of 1.7 (0.9-5.0) years and a median (IQR) CD4+ cell percentage of 15% (9%-25%); 52% were ART experienced. Eighty-five percent completed the 6 month rifabutin course with resolution of TB symptoms and 79% were retained in care at 12 months. Adverse events (grade 1-4) were more common at baseline (27%) than during rifabutin treatment (15%) (P = 0.006). Absolute neutrophil count was lower during rifabutin compared with baseline (median = 1762 versus 2976 cells/mm3, respectively), but only one instance (2%) of grade 3 neutropenia occurred during rifabutin treatment. CONCLUSIONS With clinical and laboratory monitoring, our data suggest that rifabutin is a safe option for TB therapy among children on PI-based ART. By contrast with the only other study of this combination in children, severe neutropenia was rare. Furthermore, outcomes from this cohort suggest that rifabutin is effective, and a novel option for children who require PI-based ART. Additional study of rifabutin plus PIs in children is urgently needed.
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Affiliation(s)
- Holly E Rawizza
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kristin M Darin
- Northwestern University School of Professional Studies, Chicago, IL, USA
| | - Regina Oladokun
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Biobele Brown
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Babatunde Ogunbosi
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Nkiruka David
- Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
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14
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Modelling the Anti-Methicillin-Resistant Staphylococcus Aureus (MRSA) Activity of Cannabinoids: A QSAR and Docking Study. CRYSTALS 2020. [DOI: 10.3390/cryst10080692] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Twenty-four cannabinoids active against MRSA SA1199B and XU212 were optimized at WB97XD/6-31G(d,p), and several molecular descriptors were obtained. Using a multiple linear regression method, several mathematical models with statistical significance were obtained. The robustness of the models was validated, employing the leave-one-out cross-validation and Y-scrambling methods. The entire data set was docked against penicillin-binding protein, iso-tyrosyl tRNA synthetase, and DNA gyrase. The most active cannabinoids had high affinity to penicillin-binding protein (PBP), whereas the least active compounds had low affinities for all of the targets. Among the cannabinoid compounds, Cannabinoid 2 was highlighted due to its suitable combination of both antimicrobial activity and higher scoring values against the selected target; therefore, its docking performance was compared to that of oxacillin, a commercial PBP inhibitor. The 2D figures reveal that both compounds hit the protein in the active site with a similar type of molecular interaction, where the hydroxyl groups in the aromatic ring of cannabinoids play a pivotal role in the biological activity. These results provide some evidence that the anti-Staphylococcus aureus activity of these cannabinoids may be related to the inhibition of the PBP protein; besides, the robustness of the models along with the docking and Quantitative Structure–Activity Relationship (QSAR) results allow the proposal of three new compounds; the predicted activity combined with the scoring values against PBP should encourage future synthesis and experimental testing.
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15
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Kouanda S, Ouedraogo HG, Cisse K, Compaoré TR, Sulis G, Diagbouga S, Roggi A, Tarnagda G, Villani P, Sangare L, Simporé J, Regazzi M, Matteelli A. Pharmacokinetic study of two different rifabutin doses co-administered with lopinavir/ritonavir in African HIV and tuberculosis co-infected adult patients. BMC Infect Dis 2020; 20:449. [PMID: 32590942 PMCID: PMC7318514 DOI: 10.1186/s12879-020-05169-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background This study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. Methods This is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay. Results The Cmax and AUC0–12h medians in arm A (Cmax = 296 ng/mL, IQR: 205–45; AUC0–12h = 2528 ng.h/mL, IQR: 1684–2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403–717; AUC0–12h = 4042.5 ng.h/mL, IQR: 3469–5761), with a statistically significant difference in AUC0–12h (p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit (< 300 ng/mL) in the 150 mg RBT arm, while the Cmax was above this threshold for all patients in the 300 mg RBT arm. Additionally, at 48 h after drug ingestion, all patients had a mycobacterial minimum inhibitory concentration (MIC) above the limit (> 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm. Conclusion This study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria. Trial registration PACTR201310000629390, 28th October 2013.
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Affiliation(s)
- Seni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso.
| | - Henri Gautier Ouedraogo
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso
| | - Kadari Cisse
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso
| | - Tegwinde Rebeca Compaoré
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso
| | - Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Serge Diagbouga
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso
| | - Alberto Roggi
- Institute of Infectious and Tropical Diseases, Brescia University Hospital, Brescia, Italy
| | - Grissoum Tarnagda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, 03BP7192, Burkina Faso
| | - Paola Villani
- Institute of Pharmacology, IRCCS, San Matteo University Hospital, Pavia, Italy
| | - Lassana Sangare
- Yalgado Ouedraogo University Teaching Hospital, Ouagadougou, Burkina Faso
| | - Jacques Simporé
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Mario Regazzi
- Institute of Pharmacology, IRCCS, San Matteo University Hospital, Pavia, Italy
| | - Alberto Matteelli
- Institute of Infectious and Tropical Diseases, Brescia University Hospital, Brescia, Italy
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16
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Blanc FX, Badje AD, Bonnet M, Gabillard D, Messou E, Muzoora C, Samreth S, Nguyen BD, Borand L, Domergue A, Rapoud D, Natukunda N, Thai S, Juchet S, Eholié SP, Lawn SD, Domoua SK, Anglaret X, Laureillard D. Systematic or Test-Guided Treatment for Tuberculosis in HIV-Infected Adults. N Engl J Med 2020; 382:2397-2410. [PMID: 32558469 DOI: 10.1056/nejmoa1910708] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In regions with high burdens of tuberculosis and human immunodeficiency virus (HIV), many HIV-infected adults begin antiretroviral therapy (ART) when they are already severely immunocompromised. Mortality after ART initiation is high in these patients, and tuberculosis and invasive bacterial diseases are common causes of death. METHODS We conducted a 48-week trial of empirical treatment for tuberculosis as compared with treatment guided by testing in HIV-infected adults who had not previously received ART and had CD4+ T-cell counts below 100 cells per cubic millimeter. Patients recruited in Ivory Coast, Uganda, Cambodia, and Vietnam were randomly assigned in a 1:1 ratio to undergo screening (Xpert MTB/RIF test, urinary lipoarabinomannan test, and chest radiography) to determine whether treatment for tuberculosis should be started or to receive systematic empirical treatment with rifampin, isoniazid, ethambutol, and pyrazinamide daily for 2 months, followed by rifampin and isoniazid daily for 4 months. The primary end point was a composite of death from any cause or invasive bacterial disease within 24 weeks (primary analysis) or within 48 weeks after randomization. RESULTS A total of 522 patients in the systematic-treatment group and 525 in the guided-treatment group were included in the analyses. At week 24, the rate of death from any cause or invasive bacterial disease (calculated as the number of first events per 100 patient-years) was 19.4 with systematic treatment and 20.3 with guided treatment (adjusted hazard ratio, 0.95; 95% confidence interval [CI], 0.63 to 1.44). At week 48, the corresponding rates were 12.8 and 13.3 (adjusted hazard ratio, 0.97 [95% CI, 0.67 to 1.40]). At week 24, the probability of tuberculosis was lower with systematic treatment than with guided treatment (3.0% vs. 17.9%; adjusted hazard ratio, 0.15; 95% CI, 0.09 to 0.26), but the probability of grade 3 or 4 drug-related adverse events was higher with systematic treatment (17.4% vs. 7.2%; adjusted hazard ratio 2.57; 95% CI, 1.75 to 3.78). Serious adverse events were more common with systematic treatment. CONCLUSIONS Among severely immunosuppressed adults with HIV infection who had not previously received ART, systematic treatment for tuberculosis was not superior to test-guided treatment in reducing the rate of death or invasive bacterial disease over 24 or 48 weeks and was associated with more grade 3 or 4 adverse events. (Funded by the Agence Nationale de Recherches sur le Sida et les Hépatites Virales; STATIS ANRS 12290 ClinicalTrials.gov number, NCT02057796.).
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Affiliation(s)
- François-Xavier Blanc
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Anani D Badje
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Maryline Bonnet
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Delphine Gabillard
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Eugène Messou
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Conrad Muzoora
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Sovannarith Samreth
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Bang D Nguyen
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Laurence Borand
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Anaïs Domergue
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Delphine Rapoud
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Naome Natukunda
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Sopheak Thai
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Sylvain Juchet
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Serge P Eholié
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Stephen D Lawn
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Serge K Domoua
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Xavier Anglaret
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
| | - Didier Laureillard
- From the Department of Respiratory Medicine, L'Institut du Thorax, Nantes University Hospital, and the Medical School, University of Nantes, Nantes (F.-X.B.), INSERM Unité 1219, University of Bordeaux, Bordeaux (A.D.B., D.G., X.A.), Relations Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Développement, University of Montpellier, INSERM (M.B.), and Research Unit 1058 Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier (D.L.), Montpellier, and the Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes (D.L.) - all in France; Programme ANRS (Agence Nationale de Recherches sur le Sida et les Hépatites Virales) Coopération Côte d'Ivoire, ANRS research site (A.D.B., E.M., S.J.), and Félix Houphouët-Boigny University (S.P.E., S.K.D.) - both in Abidjan, Ivory Coast; Epicentre (M.B., N.N.) and Mbarara University of Science and Technology (C.M.) - both in Mbarara, Uganda; the National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases (S.S.), Institut Pasteur du Cambodge (L.B.), and Sihanouk Hospital Center of Hope (S.T.) - all in Phnom Penh, Cambodia; Pham Ngoc Thach Hospital (B.D.N.) and ANRS, Pham Ngoc Thach Hospital (A.D., D.R.), Ho Chi Minh City, Vietnam; and the Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (S.D.L.)
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17
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Ouedraogo HG, Matteelli A, Sulis G, Compaore TR, Diagbouga S, Tiendrebeogo S, Roggi A, Cisse K, Giorgetti PF, Villani P, Sangare L, Simpore J, Regazzi M, Kouanda S. Pharmacokinetics of plasma lopinavir and ritonavir in tuberculosis-HIV co-infected African adult patients also receiving rifabutin 150 or 300 mg three times per week. Ann Clin Microbiol Antimicrob 2020; 19:3. [PMID: 31969147 PMCID: PMC6974970 DOI: 10.1186/s12941-020-0345-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To evaluate the pharmacokinetic of plasma lopinavir (LPV) and ritonavir (RTV) when co-administered with three times weekly (TPW) rifabutin (RBT) at a dose of either 150 or 300 mg in African tuberculosis (TB) and HIV co-infected adult patients. METHODS This is a pharmacokinetic study conducted in Ouagadougou among patients treated with a standard dosage of LPV/RTV 400/100 mg twice daily and RBT 150 mg TPW (arm A = 9 patients) or rifabutin 300 mg TPW (arm B = 7 patients) based regimens. Patients were recruited from the Bogodogo and Kossodo district hospitals in Ouagadougou from May 2013 to December 2015. Study inclusion criteria were that the patients were between 18 and 60 years of age, HIV-1 infected with pulmonary tuberculosis confirmed or suspected. Subsequent blood samples for pharmacokinetic monitoring were collected at 1, 2, 3, 4, 6, 8 and 12 h after combined drug ingestion for plasma drug monitoring using HPLC/MS assays. RESULTS The medians LPV Cmax and Tmax were respectively, 20 μg/mL and 4 h for the RBT 150 mg group (arm A) and 7.7 μg/mL and 3 h for the RBT 300 mg group (arm B). The AUC0-12 of LPV was 111.8 μg h/mL in patients belonging to arm A versus 69.9 μg/mL for those in arm B (p = 0.313). The C0 of LPV was lower than 4 μg/mL in three patients receiving RBT 300 mg. Of note, the RTV plasma concentrations were nearly halved among patients on RBT 300 mg compared to those on lower RBT doses. The AUC0-12 of RTV in arm A was 12.7 μg h/mL versus 6.6 μg h/ml in arm B (p = 0.313). CONCLUSION In our study, the pharmacokinetic of LPV and RTV was found to be highly variable when coadministrated with RBT 150 mg or 300 mg three times per week. There is a need for specific large study to verify clinical and virological effects of this variation, especially when coadministrated with RBT of 300 mg TPW, and to prevent viral resistance in response to under-dosing of LPV. Trial registration PACTR201310000629390. Registered 28 October 2013, http://www.pactr.org/.
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Affiliation(s)
- Henri Gautier Ouedraogo
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso.
| | - Alberto Matteelli
- Institute of Infectious and Tropical Diseases, Brescia University Hospital, Brescia, Italy
| | - Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Tegwinde Rebeca Compaore
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso
| | - Serge Diagbouga
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso
| | - Simon Tiendrebeogo
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso
| | - Alberto Roggi
- Institute of Infectious and Tropical Diseases, Brescia University Hospital, Brescia, Italy
| | - Kadari Cisse
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso
| | | | - Paola Villani
- Laboratory of Clinical Pharmacokinetics, IRCCS - San Matteo University Hospital, Pavia, Italy
| | - Lassana Sangare
- Laboratory of Virology, CHU-Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Mario Regazzi
- Laboratory of Clinical Pharmacokinetics, IRCCS - San Matteo University Hospital, Pavia, Italy
| | - Seni Kouanda
- Biomedical Research Laboratory, Institut de Recherche en Sciences de la Santé (IRSS), 03BP7192, Ouagadougou, Burkina Faso
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18
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Abstract
Approximately 20% of people with HIV in the United States prescribed antiretroviral therapy are not virally suppressed. Thus, optimal management of virologic failure has a critical role in the ability to improve viral suppression rates to improve long-term health outcomes for those infected and to achieve epidemic control. This article discusses the causes of virologic failure, the use of resistance testing to guide management after failure, interpretation and relevance of HIV drug resistance patterns, considerations for selection of second-line and salvage therapies, and management of virologic failure in special populations.
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Affiliation(s)
- Suzanne M McCluskey
- Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRJ5, Boston, MA 02114, USA.
| | - Mark J Siedner
- Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRJ5, Boston, MA 02114, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Global Health, Emory University School of Medicine, Rollins School of Public Health, Health Sciences Research Building, 1760 Haygood Dr NE, Room W325, Atlanta, GA 30322, USA
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19
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Jadhav M, Khan T, Bhavsar C, Momin M, Omri A. Novel therapeutic approaches for targeting TB and HIV reservoirs prevailing in lungs. Expert Opin Drug Deliv 2019; 16:687-699. [PMID: 31111766 DOI: 10.1080/17425247.2019.1621287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Coinfection with Mycobacterium tuberculosis is the leading cause of death in HIV positive patients. In 2017, about 0.3 million HIV positive people died of tuberculosis. There is high load of mycobacteria and HIV in the lungs and eradication of the same is vital for patient survival. AREAS COVERED This review focuses on the pathogenesis of HIV-TB coinfection and the current management approaches of this coinfection. It presents a detailed discussion of current investigations in novel drug delivery systems for effective targeting of HIV-TB lung reservoirs, especially via pulmonary drug delivery. Additionally, emphasis is given to the need of HIV-TB cotargeting, an unmet need in management of HIV-TB coinfection. EXPERT OPINION To achieve the goal of complete eradication of HIV-TB reservoirs in lungs requires focused research strategies to be undertaken in the area of pulmonary delivery systems. These endeavors could eventually lead to better patient compliance and improved treatment outcomes. The treatment regimen of HIV-TB coinfection is associated with a major drawback of low therapeutic concentration of drugs in lungs. Nanotechnology provides an excellent platform for delivery of anti-TB and anti-HIV drugs via the pulmonary route thereby serving as a viable and effective means of managing the mycobacterial and HIV reservoirs in the lungs.
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Affiliation(s)
- Mrunal Jadhav
- a Department of pharmaceutical chemistry and QA , SVKM's Dr. Bhanuben nanavati college of pharmacy , Mumbai , India
| | - Tabassum Khan
- a Department of pharmaceutical chemistry and QA , SVKM's Dr. Bhanuben nanavati college of pharmacy , Mumbai , India
| | - Chintan Bhavsar
- a Department of pharmaceutical chemistry and QA , SVKM's Dr. Bhanuben nanavati college of pharmacy , Mumbai , India
| | - Munira Momin
- a Department of pharmaceutical chemistry and QA , SVKM's Dr. Bhanuben nanavati college of pharmacy , Mumbai , India
| | - Abdelwahab Omri
- b Department of chemistry & biochemistry , Laurentian university , Sudbury , ON , Canada
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20
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McIlleron H, Chirehwa MT. Current research toward optimizing dosing of first-line antituberculosis treatment. Expert Rev Anti Infect Ther 2018; 17:27-38. [PMID: 30501530 PMCID: PMC6364307 DOI: 10.1080/14787210.2019.1555031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Drug concentrations in tuberculosis patients on standard regimens vary widely with clinically important consequences. Areas covered: We review the available literature identifying factors correlated with pharmacokinetic variability of antituberculosis drugs. Based on population pharmacokinetic models and the weight, height, and sex distributions in a large data base of African tuberculosis patients, we propose simplified weight-based doses of the available fixed dose combination(FDC) for adults with drug susceptible tuberculosis. Emerging studies will support optimized weight-based dosing for children. Other sources of important pharmacokinetic variability include genetic variants, drug-drug interactions, formulation quality, and methods of preparation and administration. Expert commentary: Optimized weight band-based dosing will result in more equitable distribution of drug exposures by weight. The use of high doses of isoniazid in patients with drug-resistant tuberculosis would be safer and more effective if a feasible test was developed to allow stratified dosing according to acetylator type. There is an urgent need for more suitable formulations of many second-line drugs for children. The adoption of new technologies and efficient FDC design may allow further advances for patients and treatment programs. Lastly, current efforts to ensure adequate quality of antituberculosis drug products are not preventing the use of substandard products to treat patients with tuberculosis.
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Affiliation(s)
- Helen McIlleron
- a Division of Clinical Pharmacology, Department of Medicine , University of Cape Town , Cape Town , South Africa
| | - Maxwell T Chirehwa
- a Division of Clinical Pharmacology, Department of Medicine , University of Cape Town , Cape Town , South Africa
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21
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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22
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Pharmacokinetics of rifabutin during atazanavir/ritonavir co-administration in HIV-infected TB patients. Indian J Tuberc 2018; 66:129-133. [PMID: 30797270 DOI: 10.1016/j.ijtb.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/30/2018] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND & OBJECTIVE Rifabutin (RBT) is the rifamycin that is recommended to treat tuberculosis (TB) in HIV-infected individuals during combination antiretroviral therapy (ART) containing HIV protease inhibitors (PIs). We studied the pharmacokinetics of rifabutin at doses of 300 mg thrice weekly and 150 mg daily during concomitant atazanavir/ritonavir (ATZ/r) administration in adult HIV-infected TB patients treated in the Revised National TB Control Programme (RNTCP) in India. METHODS This was a multi-centric study conducted in 45 adult HIV-infected TB patients, who were being treated for TB with a RBT-containing regimen and an antiretroviral treatment regimen with ATZ/r, at doses of 300 mg thrice-weekly (n = 36) or 150 mg daily (n = 9). Serial blood draws at pre-dosing and at 1, 2, 4, 6, 8, 12 and 24 hours after drug administration were done. Plasma RBT was estimated by high pressure liquid chromatography (HPLC). RESULTS The peak concentration (Cmax) of both doses were within the therapeutic range (0.45-0.90 μg/ml) of RBT. Proportion of patients having Cmax above or below the therapeutic range and trough concentration (Cmin) below the minimum inhibitory concentration of RBT did not significantly differ between the two doses. TB treatment outcomes were also similar at both doses. CONCLUSIONS This is the first and only study from India reporting on the pharmacokinetics of RBT at 300 mg thrice weekly and 150 mg daily doses. Both doses yielded similar plasma RBT concentrations, outcomes and were well tolerated. RBT can be administered at either doses during ATZ/r co-administration in HIV-infected patients with TB.
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Abstract
Tuberculosis (TB) has recently surpassed HIV as the primary infectious disease killer worldwide, but the two diseases continue to display lethal synergy. The burden of TB is disproportionately borne by people living with HIV, particularly where HIV and poverty coexist. The impact of these diseases on one another is bidirectional, with HIV increasing risk of TB infection and disease progression and TB slowing CD4 recovery and increasing progression to AIDS and death among the HIV infected. Both antiretroviral therapy (ART) and latent TB infection (LTBI) treatment mitigate the impact of coinfection, and ART is now recommended for HIV-infected patients independent of CD4 count. LTBI screening should be performed for all HIV-positive people at the time of diagnosis, when their CD4 count rises above 200, and yearly if there is repeated exposure. Tuberculin skin tests (TSTs) may perform better with serial testing than interferon gamma release assays (IGRAs). Any patient with HIV and a TST induration of ≥5 mm should be evaluated for active TB disease and treated for LTBI if active disease is ruled out. Because HIV impairs multiple aspects of immune function, progressive HIV is associated with lower rates of cavitary pulmonary TB and higher rates of disseminated and extrapulmonary disease, so a high index of suspicion is important, and sputum should be obtained for evaluation even if chest radiographs are negative. TB diagnosis is similar in patients with and without TB, relying on smear, culture, and nucleic acid amplification tests, which are the initial tests of choice. TSTs and IGRAs should not be used in the evaluation of active TB disease since these tests are often negative with active disease. Though not always performed in resource-limited settings, drug susceptibility testing should be performed on all TB isolates from HIV-positive patients. Urine lipoarabinomannan testing may also be helpful in HIV-positive patients with disseminated disease. Treatment of TB in HIV-infected patients is similar to that of TB in HIV-negative patients except that daily therapy is required for all coinfected patients, vitamin B6 supplementation should be given to all coinfected patients receiving isoniazid to reduce peripheral neuropathy, and specific attention needs to be paid to drug-drug interactions between rifamycins and many classes of antiretrovirals. In patients requiring ART that contains ritonavir or cobicistat, this can be managed by the use of rifabutin at 150 mg daily in place of rifampin. For newly diagnosed coinfected patients, mortality is lower if treatment is provided in parallel, rather than serially, with treatment initiation within 2 weeks preferred for those with CD4 counts of <50 and within 8 to 12 weeks for those with higher CD4 counts. When TB immune reconstitution inflammatory syndrome occurs, patients can often be treated symptomatically with nonsteroidal anti-inflammatory drugs, but a minority will benefit from steroids. Generally, patients who do not have space-occupying lesions such as occurs in TB meningitis do not require cessation of therapy.
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24
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Critical Review: What Dose of Rifabutin Is Recommended With Antiretroviral Therapy? J Acquir Immune Defic Syndr 2017; 72:138-52. [PMID: 26855245 DOI: 10.1097/qai.0000000000000944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since the advent of combination antiretroviral therapy to successfully treat HIV infection, drug-drug interactions (DDIs) have become a significant problem as many antiretrovirals (ARVs) are metabolized in the liver. Antituberculous therapy traditionally includes rifamycins, particularly rifampicin. Rifabutin (RBT) has shown similar efficacy as rifampicin but induces CYP3A4 to a lesser degree and is less likely to have DDIs with ARVs. We identified 14 DDI pharmacokinetic studies on HIV monoinfected and HIV-tuberculosis coinfected individuals, and the remaining studies were healthy volunteer studies. Although RBT may be coadministered with most nonnucleoside reverse transcriptase inhibitors, identifying the optimal dose with ritonavir-boosted or cobicistat-boosted protease inhibitors is challenging because of concern about adverse effects with increased RBT exposure. Limited healthy volunteer studies on other ARV drug classes and RBT suggest that dose modification may be unnecessary. The paucity of data assessing clinical tuberculosis endpoints concurrently with RBT and ARV pharmacokinetics limits evidence-based recommendations on the optimal dose of RBT within available ARV drug classes.
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Rabie H, Decloedt EH, Garcia-Prats AJ, Cotton MF, Frigati L, Lallemant M, Hesseling A, Schaaf HS. Antiretroviral treatment in HIV-infected children who require a rifamycin-containing regimen for tuberculosis. Expert Opin Pharmacother 2017; 18:589-598. [PMID: 28346018 DOI: 10.1080/14656566.2017.1309023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In high prevalence settings, tuberculosis and HIV dual infection and co-treatment is frequent. Rifamycins, especially rifampicin, in combination with isoniazid, ethambutol and pyrazinamide are key components of short-course antituberculosis therapy. Areas covered: We reviewed available data, for which articles were identified by a Pubmed search, on rifamycin-antiretroviral interactions in HIV-infected children. Rifamycins have potent inducing effects on phase I and II drug metabolising enzymes and transporters. Antiretroviral medications are often metabolised by the enzymes induced by rifamycins or may suppress specific enzyme activity leading to drug-drug interactions with rifamycins. These may cause significant alterations in their phamacokinetic and pharmacodynamic properties, and sometimes that of the rifamycin. Recommended strategies to adapt to these interactions include avoidance and dose adjustment. Expert opinion: Despite the importance and frequency of tuberculosis as an opportunistic disease in HIV-infected children, current data on the management of co-treated children is based on few studies. We need new strategies to rapidly assess the use of rifamycins, new anti-tuberculosis drugs and antiretroviral drugs together as information on safety and dosing of individual drugs becomes available.
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Affiliation(s)
- Helena Rabie
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Eric H Decloedt
- c Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa
| | - Anthony J Garcia-Prats
- d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Mark F Cotton
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Lisa Frigati
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Marc Lallemant
- e Pediatric HIV Program , Drugs for Neglected Diseases Initiative , Geneva , Switzerland
| | - Anneke Hesseling
- d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - H Simon Schaaf
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Hennig S, Svensson EM, Niebecker R, Fourie PB, Weiner MH, Bonora S, Peloquin CA, Gallicano K, Flexner C, Pym A, Vis P, Olliaro PL, McIlleron H, Karlsson MO. Population pharmacokinetic drug-drug interaction pooled analysis of existing data for rifabutin and HIV PIs. J Antimicrob Chemother 2016; 71:1330-40. [PMID: 26832753 DOI: 10.1093/jac/dkv470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Extensive but fragmented data from existing studies were used to describe the drug-drug interaction between rifabutin and HIV PIs and predict doses achieving recommended therapeutic exposure for rifabutin in patients with HIV-associated TB, with concurrently administered PIs. METHODS Individual-level data from 13 published studies were pooled and a population analysis approach was used to develop a pharmacokinetic model for rifabutin, its main active metabolite 25-O-desacetyl rifabutin (des-rifabutin) and drug-drug interaction with PIs in healthy volunteers and patients who had HIV and TB (TB/HIV). RESULTS Key parameters of rifabutin affected by drug-drug interaction in TB/HIV were clearance to routes other than des-rifabutin (reduced by 76%-100%), formation of the metabolite (increased by 224% in patients), volume of distribution (increased by 606%) and distribution to the peripheral compartment (reduced by 47%). For des-rifabutin, clearance was reduced by 35%-76% and volume of distribution increased by 67%-240% in TB/HIV. These changes resulted in overall increased exposure to rifabutin in TB/HIV patients by 210% because of the effects of PIs and 280% with ritonavir-boosted PIs. CONCLUSIONS Given together with non-boosted or ritonavir-boosted PIs, rifabutin at 150 mg once daily results in similar or higher exposure compared with rifabutin at 300 mg once daily without concomitant PIs and may achieve peak concentrations within an acceptable therapeutic range. Although 300 mg of rifabutin every 3 days with boosted PI achieves an average equivalent exposure, intermittent doses of rifamycins are not supported by current guidelines.
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Affiliation(s)
- Stefanie Hennig
- School of Pharmacy, University of Queensland, Brisbane, Australia Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden
| | - Elin M Svensson
- Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden
| | - Ronald Niebecker
- Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden
| | - P Bernard Fourie
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Marc H Weiner
- Department of Medicine, University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, TX, USA
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Charles A Peloquin
- College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | | | - Charles Flexner
- Johns Hopkins Adult AIDS Clinical Trials Unit, Division of Clinical Pharmacology, Baltimore, MD, USA
| | - Alex Pym
- Tuberculosis Research Unit, Medical Research Council and KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Durban, South Africa
| | - Peter Vis
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - Piero L Olliaro
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mats O Karlsson
- Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden
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Effect of SLCO1B1 Polymorphisms on Rifabutin Pharmacokinetics in African HIV-Infected Patients with Tuberculosis. Antimicrob Agents Chemother 2015; 60:617-20. [PMID: 26482301 DOI: 10.1128/aac.01195-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022] Open
Abstract
Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.).
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Outcomes From Treating Tuberculosis With Rifampicin or Rifabutin in HIV-Infected Persons Also Receiving Antiretroviral Therapy. J Acquir Immune Defic Syndr 2015; 68:e84-7. [DOI: 10.1097/qai.0000000000000515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mycobacterium tuberculosis: 2014 Clinical trials in review. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26:11-4. [PMID: 25798148 PMCID: PMC4353263 DOI: 10.1155/2015/984635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Regazzi M, Carvalho AC, Villani P, Matteelli A. Treatment optimization in patients co-infected with HIV and Mycobacterium tuberculosis infections: focus on drug-drug interactions with rifamycins. Clin Pharmacokinet 2015; 53:489-507. [PMID: 24777631 DOI: 10.1007/s40262-014-0144-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Tuberculosis (TB) and HIV continue to be two of the major causes of morbidity and mortality in the world, and together are responsible for the death of millions of people every year. There is overwhelming evidence to recommend that patients with TB and HIV co-infection should receive concomitant therapy of both conditions regardless of the CD4 cell count level. The principles for treatment of active TB disease in HIV-infected patients are the same as in HIV-uninfected patients. However, concomitant treatment of both conditions is complex, mainly due to significant drug-drug interactions between TB and HIV drugs. Rifamycins are potent inducers of the cytochrome P450 (CYP) pathway, leading to reduced (frequently sub-therapeutic) plasma concentrations of some classes of antiretrovirals. Rifampicin is also an inducer of the uridine diphosphate glucuronosyltransferase (UGT) 1A1 enzymes and interferes with drugs, such as integrase inhibitors, that are metabolized by this metabolic pathway. Rifampicin is also an inducer of the adenosine triphosphate (ATP) binding cassette transporter P-glycoprotein, which may also lead to decreased bioavailability of concomitantly administered antiretrovirals. On the other side, rifabutin concentrations are affected by the antiretrovirals that induce or inhibit CYP enzymes. In this review, the pharmacokinetic interactions, and the relevant clinical consequences, of the rifamycins-rifampicin, rifabutin, and rifapentine-with antiretroviral drugs are reviewed and discussed. A rifampicin-based antitubercular regimen and an efavirenz-based antiretroviral regimen is the first choice for treatment of TB/HIV co-infected patients. Rifabutin is the preferred rifamycin to use in HIV-infected patients on a protease inhibitor-based regimen; however, the dose of rifabutin needs to be reduced to 150 mg daily. More information is required to select optimal treatment regimens for TB/HIV co-infected patients whenever efavirenz cannot be used and rifabutin is not available. Despite significant pharmacokinetic interactions between antiretrovirals and antitubercular drugs, adequate clinical response of both infections can be achieved with an acceptable safety profile when the pharmacological characteristics of drugs are known, and appropriate combination regimens, dosing, and timing of initiation are used. However, more clinical research is needed for newer drugs, such as rifapentine and the recently introduced integrase inhibitor antiretrovirals, and for specific population groups, such as children, pregnant women, and patients affected by multidrug-resistant TB.
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Affiliation(s)
- Mario Regazzi
- Unit of Clinical and Experimental Pharmacokinetics, Foundation IRCCS Policlinico San Matteo, P.le Golgi 2, 27100, Pavia, Italy,
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Naiker S, Connolly C, Wiesner L, Kellerman T, Reddy T, Harries A, McIlleron H, Lienhardt C, Pym A. Randomized pharmacokinetic evaluation of different rifabutin doses in African HIV- infected tuberculosis patients on lopinavir/ritonavir-based antiretroviral therapy. BMC Pharmacol Toxicol 2014; 15:61. [PMID: 25406657 PMCID: PMC4277828 DOI: 10.1186/2050-6511-15-61] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pharmacokinetic interactions between rifampicin and protease inhibitors (PIs) complicate the management of HIV-associated tuberculosis. Rifabutin is an alternative rifamycin, for patients requiring PIs. Recently some international guidelines have recommended a higher dose of rifabutin (150 mg daily) in combination with boosted lopinavir (LPV/r), than the previous dose of rifabutin (150 mg three times weekly {tiw}). But there are limited pharmacokinetic data evaluating the higher dose of rifabutin in combination with LPV/r. Sub-optimal dosing can lead to acquired rifamycin resistance (ARR). The plasma concentration of 25-O-desacetylrifabutin (d-RBT), the metabolite of rifabutin, increases in the presence of PIs and may lead to toxicity. METHODS AND RESULTS Sixteen patients with TB-HIV co-infection received rifabutin 300 mg QD in combination with tuberculosis chemotherapy (initially pyrazinamide, isoniazid and ethambutol then only isoniazid), and were then randomized to receive isoniazid and LPV/r based ART with rifabutin 150 mg tiw or rifabutin 150 mg daily. The rifabutin dose with ART was switched after 1 month. Serial rifabutin and d-RBT concentrations were measured after 4 weeks of each treatment. The median AUC0-48 and Cmax of rifabutin in patients taking 150 mg rifabutin tiw was significantly reduced compared to the other treatment arms. Geometric mean ratio (90% CI) for AUC0-48 and Cmax was 0.6 (0.5-0.7) and 0.5 (0.4-0.6) for RBT 150 mg tiw compared with RBT 300 mg and 0.4 (0.4-0.4) and 0.5 (0.5-0.6) for RBT 150 mg tiw compared with 150 mg daily. 86% of patients on the tiw rifabutin arm had an AUC0-24 < 4.5 μg.h/mL, which has previously been associated with acquired rifamycin resistance (ARR). Plasma d-RBT concentrations increased 5-fold with tiw rifabutin dosing and 15-fold with daily doses of rifabutin. Rifabutin was well tolerated at all doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in a patient taking rifabutin 300 mg daily prior to starting ART, and grade 3 neutropenia (asymptomatic) was reported in 4 patients. These events were not associated with increases in rifabutin or metabolite concentrations. CONCLUSIONS A daily 150 mg dose of rifabutin in combination with LPV/r safely maintained rifabutin plasma concentrations in line with those shown to prevent ARR. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00640887.
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Affiliation(s)
- Suhashni Naiker
- />TB Research Unit, Medical Research Council, Durban, South Africa
| | - Cathy Connolly
- />Biostatistics Unit, Medical Research Council, Durban, South Africa
| | - Lubbe Wiesner
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracey Kellerman
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tarylee Reddy
- />Biostatistics Unit, Medical Research Council, Durban, South Africa
| | - Anthony Harries
- />International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Helen McIlleron
- />Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Alexander Pym
- />TB Research Unit, Medical Research Council, Durban, South Africa
- />KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), University of KwaZulu-Natal, Durban, South Africa
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Moultrie H, McIlleron H, Sawry S, Kellermann T, Wiesner L, Kindra G, Gous H, Van Rie A. Pharmacokinetics and safety of rifabutin in young HIV-infected children receiving rifabutin and lopinavir/ritonavir. J Antimicrob Chemother 2014; 70:543-9. [PMID: 25281400 PMCID: PMC4291235 DOI: 10.1093/jac/dku382] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Co-treatment of HIV and TB in young children is complicated by limited treatment options and complex drug–drug interactions. Rifabutin is an alternative to rifampicin for adults receiving a ritonavir-boosted PI. We aimed to evaluate the short-term safety and pharmacokinetics of rifabutin when given with lopinavir/ritonavir in children. Patients and methods We conducted an open-label study of rifabutin dosed at 5 mg/kg three times a week in HIV-infected children ≤5 years of age receiving lopinavir/ritonavir. Intensive steady-state pharmacokinetic sampling was conducted after six doses. The Division of AIDS 2004, clarification 2009, table for grading severity of adverse events was used to classify drug toxicities. The study was registered with ClinicalTrials.gov, number NCT01259219. Results Six children completed the study prior to closure by institutional review boards. The median (range) AUC0–48 of rifabutin was 6.91 (3.52–8.67) μg · h/mL, the median (range) Cmax of rifabutin was 0.39 (0.19–0.46) μg/mL, the median (range) AUC0–48 of 25-O-desacetyl rifabutin was 5.73 (2.85–9.13) μg · h/mL and the median (range) Cmax of 25-O-desacetyl rifabutin was 0.17 (0.08–0.32) μg/mL. The neutrophil count declined in all children; two children experienced grade 4 neutropenia, which resolved rapidly without complications. There was strong correlation between AUC0–48 measures and neutrophil counts. Conclusions Rifabutin dosed at 5 mg/kg three times per week resulted in lower AUC0–48, AUC0–24 and Cmax values for rifabutin and 25-O-desacetyl rifabutin compared with adults receiving 150 mg of rifabutin daily, the current recommended dose. We observed high rates of severe transient neutropenia, possibly due to immaturity of CYP3A4 in young children. It remains unclear whether a safe and effective rifabutin dose exists for treatment of TB in children receiving lopinavir/ritonavir.
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Affiliation(s)
- Harry Moultrie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gurpreet Kindra
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Hermien Gous
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Reynolds J, Heysell SK. Understanding pharmacokinetics to improve tuberculosis treatment outcome. Expert Opin Drug Metab Toxicol 2014; 10:813-23. [PMID: 24597717 DOI: 10.1517/17425255.2014.895813] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Tuberculosis (TB) remains the leading cause of death from a curable infectious disease; drug-resistant TB threatens to dismantle all prior gains in global control. Suboptimal circulating anti-TB drug concentrations can lead to lack of cure and acquired drug resistance. AREAS COVERED This review will introduce pharmacokinetic parameters for key anti-TB drugs, as well as the indications and limitations of measuring these parameters in clinical practice. Current and novel methodologies for delivering anti-TB pharmacokinetic-pharmacodynamic data are highlighted and gaps in operational research described. EXPERT OPINION Individual pharmacokinetic variability is commonplace, underappreciated and difficult to predict without therapeutic drug monitoring (TDM). Pharmacokinetic thresholds associated with poor TB treatment outcome in drug-susceptible TB have recently been described and may now guide the application of TDM, but require validation in a variety of settings and comorbidities. Dried blood spots for TDM and prepackaged multidrug plates for minimum inhibitory concentration testing will overcome barriers of accessibility and represent areas for innovation. Operationalizing pharmacokinetics has the potential to improve TB outcomes in the most difficult-to-treat forms of the disease such as multidrug resistance. Clinical studies in these areas are eagerly anticipated and we expect will better define the rational introduction of novel therapeutics.
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Affiliation(s)
- Jonathan Reynolds
- University of Virginia, School of Medicine , PO Box 801340, Charlottesville, VA 22908-1340 , USA
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