Treating HIV in People with HIV/TB Coinfection

In people with HIV/tuberculosis (TB) coinfection, antiretroviral therapy (ART) should be started soon after anti-TB therapy is initiated. Dolutegravir (DTG), an integrase inhibitor typically dosed 50 mg once daily, is a component of first-line ART regimens throughout the world. However, rifampin, an integral part of TB therapy, lowers dolutegravir levels.

Now, in an industry-supported study (INSPIRING), investigators evaluated an ART regimen containing dolutegravir dosed 50 mg twice daily in 113 people with HIV receiving rifampin-based TB therapy. Patients were randomized 3:2 to receive DTG twice daily or an efavirenz (EFV)-based ART regimen once daily, together with two nucleoside reverse transcriptase inhibitors.

At week 48, 75% of the DTG …