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Worldwide, tuberculosis (TB) is the most common opportunistic infection — and a leading cause of death — in HIV-infected individuals. Drug–drug interactions severely limit options for the treatment of TB/HIV coinfection, particularly when rifampin (RIF) is used. Based mostly on pharmacokinetic studies involving healthy volunteers in developed settings, the efavirenz package insert in the U.S. and HIV/TB treatment guidelines in the U.K. recommend an increase in the standard efavirenz dose for patients who weigh ≥50 (U.S.) or >60 (U.K.) kg and are concomitantly taking RIF. In contrast, based mostly on observational data, the WHO does not recommend such weight-based dosing.
To evaluate the relationship among weight, efavirenz concentrations, an…