University of KwaZulu-Natal, Centre for the AIDS Programme of Research in South Africa, 719 Umbilo Rd, Durban, 4013, South Africa.
Expert Opin Drug Saf. 2011 Jul;10(4):559-74. doi: 10.1517/14740338.2011.546783. Epub 2011 Jan 5.
Integrating HIV and tuberculosis (TB) treatment can reduce mortality substantially. Practical barriers to treatment integration still exist and include safety concerns related to concomitant drug use because of drug interactions and additive toxicities. Altered therapeutic concentrations may influence the chances of treatment success or toxicity.
The available data on drug-drug interactions between the rifamycin class of anti-mycobacterials and the non-nucleoside reverse transcriptase inhibitor and the protease inhibitor classes of antiretrovirals are discussed with recommendations for integrated use. Additive drug toxicities, the impact of immune reconstitution inflammatory syndrome (IRIS) and the latest data on survival benefits of integrating treatment are elucidated.
Deferring treatment of HIV to avoid drug interactions with TB treatment or the occurrence of IRIS is not necessary. In the integrated management of TB-HIV co-infection, rational drug combinations aimed at reducing toxicities while effecting TB cure and suppressing HIV viral load are possible.
将艾滋病毒和结核病（TB）的治疗结合起来可以大大降低死亡率。但治疗整合仍存在实际障碍，包括由于药物相互作用和附加毒性而导致的同时使用药物的安全问题。治疗浓度的改变可能会影响治疗成功或毒性的几率。
讨论了利福霉素类抗分枝杆菌药物与非核苷类逆转录酶抑制剂和蛋白酶抑制剂类抗逆转录病毒药物之间的药物相互作用的现有数据，并提出了联合使用的建议。阐述了附加药物毒性、免疫重建炎症综合征（IRIS）的影响以及整合治疗的最新生存获益数据。
为避免与结核病治疗或免疫重建炎症综合征（IRIS）发生的药物相互作用而推迟艾滋病毒的治疗是没有必要的。在结核病-艾滋病毒合并感染的综合管理中，可以采用合理的药物组合，在治愈结核病和抑制艾滋病毒病毒载量的同时，降低毒性。
