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. Author manuscript; available in PMC: 2011 Jan 1.
Published in final edited form as: Curr Opin HIV AIDS. 2010 Jan;5(1):61–69. doi: 10.1097/COH.0b013e3283339309

Table 1.

Antiretroviral interactions with rifampicin-based TB treatment and recommendations for co-administration in adults (References: 11, 13, 14, 24, 29-32, 34)

Class Antiretroviral agent Interaction Dose of ARV with rifampicin-based TB treatment
NRTI All in class No clinically significant pharmacokinetic interactions known. No dose adjustment required.
NNRTI Efavirenz Mild reduction in efavirenz concentrations. No dose adjustment required. 600 mg daily.
Nevirapine Moderate reduction in nevirapine concentrations. Concern about increased risk of virological failure and shared hepatotoxicity. No dose adjustment required. 200 mg 12 hrly.
Omit lead-in dose (200 mg daily) if patient has been taking rifampicin for >1 week.
PI Ritonavir Moderate reduction in ritonavir concentrations. No dose adjustment required. 600 mg 12 hrly.
This dose of ritonavir is very poorly tolerated (GIT intolerance)
Lopinavir + ritonavir Lopinavir plasma concentrations are significantly decreased. This is the preferred PI option.
Lopinavir /ritonavir (600/150 mg or 800/200 mg, both dosed 12 hrly) caused high rates of hepatitis in healthy volunteers already taking rifampicin. There are 2 dosing options:

  1. Double the dose of lopinavir/ritonavir to 800/200mg 12 hrly.

  2. Add ritonavir 300 mg 12 hrly to lopinavir/ritonavir 400/100 mg 12 hrly (resulting in lopinavir 400 mg + ritonavir 400 mg, both 12 hrly).
Regular liver function monitoring is recommended.
Caution when initiating lopinavir/ritonavir in patients already taking rifampicin.
Saquinavir + ritonavir Saquinavir concentrations are significantly decreased. Saquinavir 400 mg + ritonavir 400 mg, both 12 hrly (may be poorly tolerated − GIT intolerance).
Saquinavir 1000 mg + ritonavir 100 mg, both 12 hrly caused high rates of hepatitis in healthy volunteers already taking rifampicin. Regular liver function monitoring is recommended.
Caution when initiating saquinavir/ritonavir in patients already taking rifampicin.
All other PI’s Marked reduction in PI levels. Do not prescribe concomitantly.

NRTI = Nucleoside reverse transcriptase inhibitors, NNRTI = Non-nucleoside reverse transcriptase inhibitors, PI = Protease inhibitors, GIT = gastro-intestinal tract.