Double-dose lopinavir/ritonavir not feasible treatment for children with HIV and TB receiving rifampicin

MONTREAL – Pediatric patients who have both HIV and tuberculosis should not be treated with a double dose of lopinavir/ritonavir if they are also receiving rifampicin-based anti-tuberculosis treatment, according to results presented at the 16th Annual Conference on Retroviruses and Opportunistic Infections, held here.

Helen McIlleron, PhD, from the University of Cape Town in South Africa, presented results demonstrating that treating pediatric patients with HIV and TB with a double dose of lopinavir/ritonavir (Kaletra, Abbott) may result in significant reductions in lopinavir concentrations when they are already being treated with rifampicin-based anti-TB treatments. McIlleron said the researchers had hypothesized that a double dose of lopinavir/ritonavir might have helped to overcome the inducing effects of rifampicin. Previous studies demonstrated that this was the case in adults coinfected with HIV and TB.

McIlleron and her colleagues studied a cohort of 39 children with HIV aged at least 6 months. Fifteen of the children were coinfected with TB; these patients served as the cases group. The remaining 24 patients did not have TB and served as the control group.

Patients were given twice the recommended dose of lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors. Plasma lopinavir concentrations were measured before dosing and at two, four, eight and 12 hours following dosing.

At 12 hours following dosing, the average lopinavir concentrations in the cases group were 0.65 mg/L more than they were at baseline. A similar reduction was not seen among the control group. – by Jay Lewis

This is an important finding and could have significant practical impact in parts of the world where TB and HIV co-infection are common. In the United States, TB and HIV coinfection is relatively uncommon.

– Mobeen H. Rathore, MD

Director
University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)

For more information:

McIlleron. #98. Presented at: the 16th Annual Conference on Retroviruses and Opportunistic Infections; Feb. 8-11, 2009; Montreal.