Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island 02906, USA.
Expert Opin Drug Metab Toxicol. 2010 Jan;6(1):55-68. doi: 10.1517/17425250903393752.
HIV/tuberculosis (TB) co-infection is common and associated with high mortality. Simultaneous highly active antiretroviral therapy during TB treatment is associated with substantial survival benefit but drug-drug interactions complicate NNRTI dosing.
We reviewed the impact of rifampicin-containing TB therapy on the NNRTIs pharmacokinetics and clinical outcome. PubMed database was searched from 1966 to July 2009 using the terms efavirenz, rifampicin, nevirapine, pharmacokinetics, pharmacogenetics, HIV, TB, CYP2B6, CYP3A4 and metabolism. References from identified articles and abstracts from meetings were also reviewed.
A comprehensive review of the literature on this subject including pharmacokinetic and clinical studies. Most studies were small, observational or underpowered to detect the true effect of rifampicin on NNRTI-based therapy. None of the studies were controlled for genetic factors and there were limited data on children.
There were insufficient data to make definitive recommendations about dose adjustment of the NNRTIs during rifampin-containing therapy. Current data suggest that the standard dose of efavirenz or nevirapine is adequate in most HIV/TB co-infected adults. However, more research is needed in pediatric populations as well as to define role of drug-gene interactions.
艾滋病毒/结核病（TB）合并感染很常见，并且与高死亡率相关。在结核病治疗期间同时进行高效抗逆转录病毒治疗与显著的生存获益相关，但药物相互作用使 NNRTI 剂量复杂化。
我们回顾了含利福平的结核病治疗对 NNRTIs 药代动力学和临床结果的影响。使用 efavirenz、rifampicin、nevirapine、pharmacokinetics、pharmacogenetics、HIV、TB、CYP2B6、CYP3A4 和 metabolism 等术语，从 1966 年至 2009 年 7 月在 PubMed 数据库中进行了搜索。还回顾了从已确定文章和会议摘要中获得的参考文献。
对该主题的文献进行全面回顾，包括药代动力学和临床研究。大多数研究规模较小，为观察性研究或研究力度不足，无法检测利福平对基于 NNRTI 的治疗的真实影响。这些研究均未控制遗传因素，并且儿童的数据有限。
关于利福平治疗期间调整 NNRTI 剂量的明确建议，目前数据不足。目前的数据表明，在大多数 HIV/TB 合并感染的成年人中，依非韦伦或奈韦拉平的标准剂量是足够的。然而，在儿科人群中以及在定义药物-基因相互作用的作用方面，还需要更多的研究。
