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Friday 21st October 2016

Best drug for HIV and TB

18th August 2008

Researchers have come down on the side of a more expensive antiretroviral drug as the most effective in the treatment of new tuberculosis infections in HIV patients.


The drug efavirenz was recommended for TB patients who contract HIV while taking their anti-tuberculosis medication.

According to a study of 4,000 newly diagnosed HIV patients in South Africa, patients who took the drug had lower viral loads in their blood at the end of the study than those who took nevirapine.

Some of the participants already had TB and were taking rifampicin, which slows down the liver's ability to process nevirapine, making the anti-HIV drug less effective and causing an increase in virus levels.

Nevirapine is the cheaper of the two drugs.

However, the complexity of treating concurrent HIV and TB infections was highlighted by the finding that HIV-infected patients who were already on antiretroviral drugs when they subsequently developed TB were unaffected by efavirenz.

In a study published in the Journal of the American Medical Association, researchers from the Western Cape provincial health department, Médecins Sans Frontières and the University of Cape Town (UCT) said however that the research was not a rejection of nevirapine.

Study leader Andrew Boulle said four out of five of our patients in the study continued to do well on nevirapine, which is popular in the developing world because of its low cost, simplicity of use and its safety for pregnant HIV-infected women.

Katherine Hildebrand, another UCT researcher, said efavirenz, which is twice the price of nevirapine, was only slightly affected by rifampicin.

She called for measures to reduce the price of efavirenz, which was found to be more effective in the normal doses, disproving earlier assumptions that people with both TB and HIV may need increased doses of efavirenz, which is used extensively in Botswana and South Africa.

Gary Maartens, of UCT medical school's clinical pharmacology division, said efavirenz should be used unless there were compelling reasons not to, or unless there was no access to the drug, as is the case in some developing countries.


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