Lopinavir/ritonavir and rifampin: is coadministration possible?

SummaryThe necessity of concomitant treatment of tuberculosis and HIV infection in the same patient creates a therapeutic challenge due to drug-drug interactions. The most problematic issue is coadministration of rifamycins with protease inhibitor (PI) – based antiretroviral regimens. One of the PIs, commonly used in Poland is lopinavir/ritonavir (LPV/r), and the only rifamycin directly available is rifampin. It is well known that rifampin dramatically decreases lopinavir plasma levels. In the view of different studies, coadministration of LPV/r with rifampin, despite attempts to compensate the interaction with dosage adjustment or additional ritonavir, is not advisable because of toxicity. In such situations, rifabutin should be a drug of choice. It can be taken as 1/4 of normal dosage. LPV/r dosage does not need to be changed. In Poland, rifabutin can be obtained through special importing procedure.