Interactions between antiretroviral agents and those used to treat tuberculosis
Interactions between antiretroviral agents and those used to treat tuberculosis
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DOI：
10.1097/coh.0b013e3282fbaad0
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发表时间：
2008-05-01
影响因子：
4.1
通讯作者：
Di Perri, Giovanni
中科院分区：
文献类型：
--
作者：
Bonora, Stefano;Di Perri, Giovanni
综述的目的：已知蛋白水解酶抑制剂、非核苷类逆转录酶抑制剂和利福霉素的代谢特性显著影响这些化合物在HIV/结核病双重感染者中联合给药的可能性。在这篇综述中，将讨论抗逆转录病毒药物和抗结核药物之间药物相互作用的最新研究结果。最近的发现虽然蛋白酶抑制剂被证实与含有利福平的抗结核方案不相容，但在过去的一年里，现有的非核苷逆转录酶抑制剂获得了有希望的数据。特别是，奈韦拉平在亚洲和非洲人群中与利福平相关时，在标准剂量下被证明是安全和有效的，这表明相互作用是基于药物遗传学的个体间差异。另一方面，尽管新的抗逆转录病毒药物，如整合酶抑制剂、进入抑制剂和最新的非核苷逆转录酶抑制剂的相互作用尚未得到充分研究，但可以预见与利福霉素配伍的潜在临床问题。总结含有利福平的抗结核方案似乎与基于非核苷逆转录酶抑制剂的抗逆转录病毒疗法兼容，尽管后者的剂量调整需求可能因个体而异。有必要进行药物遗传学研究，以确定一种可能的定位个体化策略，特别是对于非核苷类逆转录酶抑制剂是主要抗逆转录病毒选择的发展中国家。新上市的药物和正在开发的抗艾滋病毒和抗结核病药物似乎并不是没有这些药理上的相互作用。
Purposes of reviewMetabolic features of protease inhibitors, nonnucleoside reverse transcriptase inhibitors and rifamycins are known to significantly affect the possibility of coadministration of these compounds in HIV/tuberculosis dually infected subjects. In this review recent findings on drug-drug interactions between antiretroviral and antituberculous agents will be discussed.Recent findingsWhile protease inhibitors were confirmed to be not compatible with rifampin-containing anti-tuberculosis regimens, in the last year promising data were obtained for existing nonnucleoside reverse transcriptase inhibitors. Nevirapine, particularly, was shown to be safe and effective at standard dosing when associated with rifampin in Asian and African populations, suggesting a pharmacogenetics-based interindividual variability of interaction. On the other hand, although the interaction profiles of new antiretrovirals, such as integrase inhibitors, entry inhibitors and most recent nonnucleoside reverse transcriptase inhibitors, have not yet been fully investigated, potential clinical problems of compatibility with rifamycins could be anticipated.SummaryRifampin-containing antituberculous regimens seem compatible with nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapies, although the need for dose adjustments of the latter probably varies on individual basis. Pharmacogenetic studies aimed to define a possible strategy of posological individualization are warranted, especially for developing countries where nonnucleoside reverse transcriptase inhibitors are the main antiretroviral option. The newly marketed drugs and drugs under development in both anti-HIV and anti-tuberculosis settings seem not to be devoid of these pharmacological interactions.