PMID- 31809218 OWN - NLM STAT- MEDLINE DCOM- 20200109 LR - 20231113 IS - 1744-764X (Electronic) IS - 1474-0338 (Print) IS - 1474-0338 (Linking) VI - 19 IP - 1 DP - 2020 Jan TI - Safety implications of combined antiretroviral and anti-tuberculosis drugs. PG - 23-41 LID - 10.1080/14740338.2020.1694901 [doi] AB - Introduction: Antiretroviral and anti-tuberculosis (TB) drugs are often co-administered in people living with HIV (PLWH). Early initiation of antiretroviral therapy (ART) during TB treatment improves survival in patients with advanced HIV disease. However, safety concerns related to clinically significant changes in drug exposure resulting from drug-drug interactions, development of overlapping toxicities and specific challenges related to co-administration during pregnancy represent barriers to successful combined treatment for HIV and TB.Areas covered: Pharmacokinetic interactions of different classes of ART when combined with anti-TB drugs used for sensitive-, drug-resistant (DR) and latent TB are discussed. Overlapping drug toxicities, implications of immune reconstitution inflammatory syndrome (IRIS), safety in pregnancy and research gaps are also explored.Expert opinion: New antiretroviral and anti-tuberculosis drugs have been recently introduced and international guidelines updated. A number of effective molecules and clinical data are now available to build treatment regimens for PLWH with latent or active TB. Adopting a systematic approach that also takes into account the need for individualized variations based on the available evidence is the key to successfully integrate ART and TB treatment and improve treatment outcomes. FAU - Cerrone, Maddalena AU - Cerrone M AUID- ORCID: 0000-0002-6900-6086 AD - Department of Medicine, Imperial College London, London, UK. AD - Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory, South Africa. AD - Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK. AD - The Francis Crick Institute, London, UK. FAU - Bracchi, Margherita AU - Bracchi M AD - Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK. FAU - Wasserman, Sean AU - Wasserman S AUID- ORCID: 0000-0002-3508-6719 AD - Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory, South Africa. AD - Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa. FAU - Pozniak, Anton AU - Pozniak A AD - Department of HIV, Chelsea and Westminster Hospital NHS Trust, London, UK. AD - The London School of Hygiene & Tropical Medicine, London, UK. FAU - Meintjes, Graeme AU - Meintjes G AD - Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory, South Africa. FAU - Cohen, Karen AU - Cohen K AUID- ORCID: 0000-0002-1892-4207 AD - Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Rondebosch, South Africa. FAU - Wilkinson, Robert J AU - Wilkinson RJ AUID- ORCID: 0000-0002-2753-1800 AD - Department of Medicine, Imperial College London, London, UK. AD - Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Observatory, South Africa. AD - The Francis Crick Institute, London, UK. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - 104803/WT_/Wellcome Trust/United Kingdom GR - 203135/WT_/Wellcome Trust/United Kingdom GR - U01 AI115940/AI/NIAID NIH HHS/United States PT - Journal Article PT - Review DEP - 20191206 PL - England TA - Expert Opin Drug Saf JT - Expert opinion on drug safety JID - 101163027 RN - 0 (Anti-HIV Agents) RN - 0 (Antitubercular Agents) SB - IM MH - Animals MH - Anti-HIV Agents/*administration & dosage/adverse effects/pharmacokinetics MH - Antitubercular Agents/*administration & dosage/adverse effects MH - Drug Interactions MH - HIV Infections/drug therapy MH - Humans MH - Latent Tuberculosis/drug therapy MH - Tuberculosis/drug therapy PMC - PMC6938542 MID - NIHMS1546423 OTO - NOTNLM OT - HIV OT - Tuberculosis OT - antiretroviral OT - drug interactions OT - safety OT - toxicity COIS- Declaration of interest M Cerrone has received a travel grant from Gilead over 2 years ago. RJ Wilkinson has performed consultancy on vaccines against tuberculosis for GSK. RJ Wilkinson receives support from Wellcome (104803, 203135) and the Francis Crick institute which is funded by Wellcome (FC0010218), UKRI (FC0010218) and CRUK (FC0010218); NIH (U01 AI 5940); EDCTP (SRIA 2015-1065); FNIH (WILKI16PTB). A Pozniak joins advisory boards and symposia for ViiV, Gilead, Janssen and Merck. A Pozniak chairs BHIVA TB guidelines, is a panel member on the EACS OI guidelines committee, and a member of the WHO ARV guidelines committee. G Meintjes was supported by the Wellcome Trust (098316 and 203135/Z/16/Z), the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787), NRF incentive funding (UID: 85858) and the South African Medical Research Council through its TB and HIV Collaborating Centres Programme with funds received from the National Department of Health (RFA# SAMRC-RFA-CC). S Wasserman is supported by the European & Developing Countries Clinical Trials Partnership (CDF1018) and Wellcome Trust (203135/Z/16/Z). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. EDAT- 2019/12/07 06:00 MHDA- 2020/01/10 06:00 PMCR- 2021/01/01 CRDT- 2019/12/07 06:00 PHST- 2019/12/07 06:00 [pubmed] PHST- 2020/01/10 06:00 [medline] PHST- 2019/12/07 06:00 [entrez] PHST- 2021/01/01 00:00 [pmc-release] AID - 10.1080/14740338.2020.1694901 [doi] PST - ppublish SO - Expert Opin Drug Saf. 2020 Jan;19(1):23-41. doi: 10.1080/14740338.2020.1694901. Epub 2019 Dec 6.