Autar Reshma S, Wit Ferdinand W N M, Sankote Jongkol, Mahanontharit Apicha, Anekthananon Thanomsak, Mootsikapun Piroon, Sujaikaew Khanjtta, Cooper David A, Lange Joep M A, Phanuphak Praphan, Ruxrungtham Kiat, Burger David M
The HIV-Netherlands Australia Thailand Research Collaboration, Thai Red Cross Aids Research Center, Bangkok, Thailand.
Antivir Ther. 2005;10(8):937-43.
In countries with high numbers of HIV/tuberculosis coinfection nevirapine and rifampin are used extensively. However, limited data are available about whether or not nevirapine and rifampin can be safely coadministered without the plasma concentration of nevirapine falling below therapeutic levels.
Blood samples for determination of nevirapine plasma concentrations were collected from patients using nevirapine 200 mg twice daily with or without concomitant rifampin. Bivariate and multivariate linear regression models were used to investigate factors possibly related to nevirapine concentrations.
We received 74 blood samples from patients using nevirapine plus rifampin, and collected blood samples from an equal number of controls using nevirapine only. Groups were similar for age, gender, weight, height and body mass index (BMI). In the rifampin group the mean nevirapine concentration was 5.47 +/- 2.66 mg/l, whereas in the control group the mean nevirapine concentration was 8.72 +/- 3.98 mg/l. In the rifampin group seven nevirapine trough concentrations were low (< 3.1 mg/l), while in the control group two patients had low nevirapine trough concentrations (P = 0.164). In the multivariate linear regression analysis, corrected for time after drug intake, the use of rifampin was significantly (P < 0.001) associated with lower nevirapine plasma concentrations, whereas higher BMI reached borderline significance (P = 0.065).
Although nevirapine plasma concentrations were 3.3 mg/l lower when co-administered with rifampin, still more than 86% of these patients had nevirapine plasma concentrations > 3.1 mg/l. Our results suggest that from a pharmacological point of view the majority of Thai coinfected patients, who have low BMIs, reach nevirapine plasma concentrations that are adequate for treatment of HIV. However this can only be undertaken if nevirapine plasma concentration monitoring is available and can be closely followed.
在艾滋病毒/结核病合并感染率高的国家，奈韦拉平和利福平被广泛使用。然而，关于奈韦拉平和利福平能否安全联用且奈韦拉平血浆浓度不低于治疗水平的可用数据有限。
从每日两次使用200毫克奈韦拉平的患者中采集血样以测定奈韦拉平血浆浓度，这些患者有的同时使用利福平，有的未使用。采用双变量和多变量线性回归模型研究可能与奈韦拉平浓度相关的因素。
我们从使用奈韦拉平加用利福平的患者中收到74份血样，并从同等数量仅使用奈韦拉平的对照患者中采集血样。两组在年龄、性别、体重、身高和体重指数（BMI）方面相似。在利福平组中，奈韦拉平的平均浓度为5.47±2.66毫克/升，而在对照组中，奈韦拉平的平均浓度为8.72±3.98毫克/升。在利福平组中，7例奈韦拉平谷浓度较低（<3.1毫克/升），而在对照组中，有2例患者奈韦拉平谷浓度较低（P = 0.164）。在多变量线性回归分析中，校正药物摄入后的时间后，使用利福平与较低的奈韦拉平血浆浓度显著相关（P < 0.001），而较高的BMI达到临界显著性（P = 0.065）。
虽然与利福平联用时奈韦拉平血浆浓度低3.3毫克/升，但这些患者中仍有超过86%的奈韦拉平血浆浓度>3.1毫克/升。我们的结果表明，从药理学角度来看，大多数BMI较低的泰国合并感染患者的奈韦拉平血浆浓度足以治疗艾滋病毒。然而，这只有在有奈韦拉平血浆浓度监测且能密切跟踪的情况下才能进行。
