Special considerations: TB/HIV coinfection

The approach to designing MDR/RR-TB treatment regimens is largely the same for all children and adolescents, regardless of HIV status, although potential drug–drug interactions should be avoided through the careful selection of TB medicines in the regimen.19

The most important clinically significant drug–drug interaction with ART that must be considered is for bedaquiline. ART regimens including integrase inhibitors such as DTG are the best option for children living with HIV receiving bedaquiline, as clinically significant drug–drug interactions are not expected. ART regimens that contain EFV should be avoided in children and adolescents while they are on bedaquiline, as EFV substantially lowers the concentrations of bedaquiline (118). Other options
for children living with HIV on ART receiving bedaquiline are:

  • LPV/r – co-treatment with LPV/r may result in elevated bedaquiline exposures, but experience has not shown this to result in an increase in adverse effects, so this may be considered with careful monitoring (119, 120).
  • NVP – the reduced efficacy of NVP-containing regimens means this is not an ideal choice when other options are available and as, indicated above, substitution with EFV is not an option. 
  • Triple nucleoside reverse-transcriptase inhibitor (NRTI) regimen – this is not recommended routinely if there are other options, especially if the viral load is high, as this regimen has reduced potency.

19 A useful tool to check drug–drug interactions can be found at https://www.hiv-druginteractions.org/

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