8.6.3
Overlapping ARV and TB drug side effects
National TB Management Guidelines, 2018 Edition. Chapter 8, TB and HIV.
Clinical description
- Concurrent use of ARVs and TB drugs has the potential for added toxicity.
62 National Tuberculosis Control Programme
- The most common causes of skin rashes are pyrazinamide, isoniazid and rifampicin.
- ARVs such as nevirapine and efavirenz can also cause skin rashes.
- These overlapping side effects make it difficult to identify the causative drug when a
patient is receiving treatment for both TB and HIV concurrently.
- NVP, ATV/r, LPV/r ,DTG and DRV have significant interactions with rifampicin. Do not
combine if possible.11
- Patients on both treatments need a thorough history and clinical assessment to
establish which drug is responsible for he Side Effects.
Table 8.6-1: Relevant Drug interactions between ARVs and TB drugs Isoniazid Rifampicin Rifapentine Streptomycin Ethambutol Pyrazinamide TDF OK OK OK renal toxicity OK OK AZT OK OK OK OK OK OK 3TC OK OK OK OK OK OK OK poss.
DTG OK hypersensitivity OK OK OK double (don’t combine)
DTG dose no experience EFV OK OK skin rash OK hepatitis needs EFV ↑ start NVP no experience full dose, NVP skin rash skin rash OK hepatitis needs NVP↑ hepatitis ABC OK OK OK OK OK OK no experience no experience ATV/r OK OK OK OK (don’t (don’t combine)
combine)
major dose no experience LPV/r OK OK OK OK adjustment (don’t combine)
**** source : Malawi Clinical HIV Guidelines 2018.Department of HIV /AIDS
- Combination usually does not cause a problem, but vigilant monitoring for increased toxicity
required 11 Malawi Clinical HIV Guidelines 2018.Department of HIV /AIDS.
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