Table 1.
Overlapping Syndromes and Combined Toxicity of Drugs Used to Treat Tuberculosis and Human Immunodeficiency Virus (HIV) Infection
| Adverse Event | Potential Causes |
|---|---|
| Febrile, Generally Unwell | IRIS, Paradoxical IRIS, Drug-Resistant Tuberculosis |
| Rash | Isoniazid, pyrazinamide, rifampicin, PAS, abacavir, nevirapine, efavirenz, stavudine, others,a HIV infection |
| Hepatotoxicity | Isoniazid, ethionamide, prothionamide, rifampicin, pyrazinamide, thiacetazone, nevirapine, efavirenz, ritonavir, and other PIs, NRTIs, paradoxical IRIS, hepatitis virus flares; rarely: fluoroquinolones, PAS |
| Neuropathy | Isoniazid, linezolid, ethionamide, prothionamide, cycloserine, terizidone, stavudine, didanosine, zalcitabine, HIV infection |
| Ophthalmologic problems | Ethambutol, rifabutin, linezolid, ethionamide, prothionamide, didanosine |
| CNS toxicity | Efavirenz, cycloserine, terizidone, ethionamide, prothionamide, isoniazid |
| QT interval prolongation | Lopinavir, atazanavir, moxifloxacin, gatifloxacin, levofloxacin, clarithromycin |
| Arthropathies/arthralgia | Pyrazinamide, fluoroquinolones, PAS, HIV infection |
| Gastrointestinal disturbance | Ethionamide, prothionamide, PAS, clofazimine, isoniazid, ethambutol, pyrazinamide, ritonavir, stavudine, nevirapine, others |
| Pancreatitis | Stavudine, didanosine, zalcitabine, linezolid |
| Lactic acidosis | Stavudine, didanosine, zidovudine, linezolid |
| Renal impairment, electrolyte disturbance | Aminoglycosides, capreomycin, tenofovir, HIV infection |
| Hematological abnormalities | Linezolid, rifabutin, rifampicin, isoniazid, zidovudine, trimethoprim-sulfamethoxazole, HIV infection, tuberculosis |
| Hypothyroidism | Ethionamide, prothionamide, PAS, stavudine, HIV infection |
| Dysglycemia | Protease inhibitors, fluoroquinolones, ethionamide, prothionamide, isoniazid |
Reproduced with permission of S. Karger AG, Basel (McIlleron H, Khoo SH. Interactions between antituberculosis and antiretroviral agents, in Progress in Respiratory Research 2011 doi: 10.1159/000324217).
Abbreviations: CNS, central nervous system; HIV, human immunodeficiency virus; IRIS, immune reconstitution inflammatory syndrome; NRTI, nucleoside reverse transcriptase inhibitor; PAS, para-aminosalicylic acid; PI, protease inhibitor.
a Thiacetazone is contraindicated in HIV-infected patients because of severe reactions and is no longer readily available.