Tuberculosis Treatments

CDC Guidelines: HIV Drug Interactions

The CDC publishes an excellent set of guidelines to tuberculosis treatments for HIV-infected patients.

Click here for access:
Updated Guidelines for the Use of Rifabutin or Rifampin for the Treatment and Prevention of Tuberculosis Among HIV-Infected Patients Taking Protease Inhibitors or Nonnucleoside Reverse Transcriptase Inhibitors

These drug interactions principally result from changes in metabolism of anti-retroviral agents and rifamycins secondary to induction or inhibition of the cytochrome CYP450 enzyme system. Of the rifamycins, rifampin (RIF) is the most potent CYP450 inducer and rifabutin (RFB) has substantially less activity as an inducer.

The following data related to dosages and types of rifamycins to be used with or not used with PIs and NNRTIs include:

  • Drugs that can be given with rifampin (RIF)
    • Ritonavir in usual dose and rifampin 600 mg/day
    • Efavirenz is increased to 800 mg/day and rifampin 600
    • Nevirapine dose is 200 mg 2 times per day and rifampin 600 mg/day

  • Drugs that should not be given with rifampin (RIF)
    • Amprenavir
    • fos-Amprenavir
    • Atazanavir
    • Indinavir
    • Nelfinavir
    • Sequinavir
    • Delaviridine

  • Drugs that can be given with Rifabutin (RFB)
    • Amprenavir at usual dose and rifabutin 150 mg/day or 150 mg 3 times per week
    • fos-Amprenavir at usual dose and rifabutin 150 mg/day or 150 mg 3 times per week
    • Atazanavir at usual dose and rifabutin 150 mg/day
    • Indinavir at a dose of 1000 mg q8h and rifabutin 150 mg/day or 150 mg 3 times per week
    • Nelfinavir at a dose of 1000 mg q8h and rifabutin 150 mg/day or 150 mg 3 times per week
    • Ritonavir at usual dose and rifabutin 150 mg/day or 150 mg 3 times per week
    • Efavirenz at usual dose and rifabutin 450 mg/day or 600 mg 3 times per week
    • Nevirapine at usual dose and rifabutin 300 mg/day or 300 mg 3 times per week

  • Drugs which should not be given with either rifampin or rifabutin
    • Saquinavir
    • Delaviridine


For further data with regard to HIV drug combinations with either rifampin or rifabutin during tuberculosis treatments, consult:
Updated Guidelines for the Use of Rifabutin or Rifampin for the Treatment and Prevention of Tuberculosis Among HIV-Infected Patients Taking Protease Inhibitors or Nonnucleoside Reverse Transcriptase Inhibitors






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