TB Treatment Makes HIV Treatment Less Effective

Nevirapine Not as Successful When Combined with Rifampicin

Sep 7, 2008

A new study conducted in South Africa shows that tuberculosis treatment medications may make HIV anti-retroviral treatment less effective.

A study published in the August 6, 2008, issue of the Journal of the American Medical Association shows that the use of rifampicin makes nevirapine treatment for HIV less effective. The study, conducted in South Africa between 2001 and 2006, showed that nevirapine treatment for HIV was less effective than efavirenz when taken with rifampicin for tuberculosis (TB).

Those taking rifampicin and nevirapine together had 20-55% lower levels of nevirapine in their plasma than expected. When taken together, patients receiving both treatments had a higher HIV viral load, the amount of virus in their body, for the first two years they were receiving therapy.

Nevirapine is a commonly used for HIV anti-retroviral treatment (ART) in resource limited countries. Navirapine is cheaper than efavirenze and is approved for use in pregnant women and women of childbearing years. Efavirenz, on the other hand, is not approved for use during pregnancy or by women who may become pregnant since it has been shown to cause birth defects. It is also a more expensive treatment option.

Tuberculosis and HIV Co-infection

HIV causes the immune system to become weak, allowing other infections to easily make the person sick. TB is one of the most common infections that affect HIV-positive individuals. Since tuberculosis commonly occurs early in HIV infection, it can be the first indication that an individual has HIV. The sooner an HIV-positive individual begins taking ART, the more likely they are to avoid contracting TB.

An Overview of Tuberculosis

Tuberculosis is an infectious disease that can affect many parts of the body, but most often affects the lungs. TB infection can be either active or inactive. If TB is active, the infected person can pass the disease on to anyone they come in close contact with. If TB goes untreated, the infected person will infect roughly ten to fifteen people each year.

People who have inactive, or latent, TB do not have any symptoms, feel fine, and cannot pass the disease on to others. Inactive TB can become active TB if the immune system becomes compromised due to another illness, like HIV.

A combination of antibiotics almost always cures TB. Once an infected person begins taking antibiotics, they quickly become non-contagious. Typically, once a person is on treatment for 6-8 months they are cured, but they can become infected again if they are exposed to TB.

TB is the leading cause of death in Africa among those who are HIV-positive. Tuberculosis progresses faster and is more likely to be fatal in those with HIV. In 2006, 1.7 million people died from TB. In the same year, 9.2 million new cases were diagnosed; 7.8 million of those were in Asia and sub-Saharan Africa

Boulle, A., Van Cutsem, G., Cohen, C., et al. (2008). Outcomes of Nevirapine- and Efavirenz-Based Antiretroviral Therapy When Coadministered with Rifampicin- based Antitubercular Therapy. The Journal of the American Medical Association. 300(5): 530-539.

The copyright of the article TB Treatment Makes HIV Treatment Less Effective in Aids/HIV Treatment is owned by Jamie Robertson. Permission to republish TB Treatment Makes HIV Treatment Less Effective in print or online must be granted by the author in writing.