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The optimal dosing strategy for raltegravir in HIV-infected patients with tuberculosis (TB) is not clear. The package insert recommends doubling the dose when the drug is administered with rifampin, because rifampin lowers trough concentrations by 60% and AUC by 40%. However, until recently, there were no comparative studies of raltegravir in HIV-related TB.
At this year's International AIDS Conference, Nathalie De Castro presented the 24-week results of a phase II, open-label, randomized trial comparing three strategies for initial HIV treatment in patients with TB: efavirenz 600 mg once daily, raltegravir 400 mg twice daily, and raltegravir 800 mg twice daily, each together with tenofovir and 3TC. The primary endpoint was the proportion of…