ART for HIV/TB-Coinfected Patients Taking Rifampicin: Efavirenz or Nevirapine?

For patients with concurrent HIV infection and tuberculosis (TB) who are taking rifampicin-based anti-TB therapy, PIs are contraindicated because of drug–drug interactions. We therefore have to rely on NNRTIs — but which one is best? In a recent open-label, randomized, comparative trial involving 142 HIV/TB-coinfected patients in Thailand who were receiving rifampicin, researchers assessed the efficacy of nevirapine- and efavirenz-based antiretroviral therapy (ART) regimens. They also examined rifampicin’s effect on plasma efavirenz and nevirapine levels.

At week 48 of ART, 73.2% of the efavirenz group and 71.8% of the nevirapine group had achieved undetectable viral loads (P>0.99). No significant between-group differences were seen in rates…