Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Updated

Sep. 27, 2019

Reviewed

Oct. 13, 2021

Tables

Table 3. Dosing Recommendations for Anti-TB Drugs for Treatment of Active Drug Sensitive TB

Table 3. Dosing Recommendations for Anti-TB Drugs for Treatment of Active Drug Sensitive TB
TB Drug	ARV Drugs	Daily Dose
Isoniazid	All ARVs	5 mg/kg (usual dose 300 mg)
Rifampin^a,b Note: DTG, RAL, and MVC doses need to be adjusted when used with rifampin	With HIV PIs, DOR, ETR, RPV, BIC, or EVG/c	Not recommended
	With TAF	Use with caution^c at dose indicated below
	With other ARV drugs	10 mg/kg (usual dose 600 mg)
Rifabutin^a Note: DOR and RPV doses need to be adjusted when used with rifabutin	With PI with COBI, TAF, BIC, or EVG/c - containing regimens	Not recommended
	With DTG, RAL, EFV, DOR, RPV	5 mg/kg (usual dose 300 mg)
	With HIV PIs with RTV	150 mg^d
	With EFV	450–600 mg
Pyrazinamide	All ARVs	Weight-Based Dosing Weighing 40–55 kg: 1,000 mg (18.2–25.0 mg/kg) Weighing 56–75 kg: 1,500 mg (20.0–26.8 mg/kg) Weighing 76–90 kg: 2,000 mg (22.2–26.3 mg/kg) Weighing >90 kg: 2,000 mg^e
Ethambutol	All ARVs	Weight-Based Dosing Weighing 40–55 kg: 800 mg (14.5–20.0 mg/kg) Weighing 56–75 kg: 1,200 mg (16.0–21.4 mg/kg) Weighing 76-90 kg: 1,600 mg (17.8–21.1 mg/kg) Weighing >90 kg: 1,600 mg^e
^a For more detailed guidelines on use of different ARV drugs with rifamycin, clinicians should refer to the Drug-Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines ^b Higher doses may be needed in the treatment of TB meningitis. Expert consultation is advised. ^c This combination has not been tested in patients to confirm PK and virologic efficacy among patients taking full dose ART and TB regimens ^d Acquired rifamycin resistance has been reported in patients with inadequate rifabutin levels while on 150 mg twice weekly dosing together with RTV-boosted PIs. May consider TDM when rifabutin is used with an RTV-boosted PI and adjust dose accordingly. ^e Monitor for therapeutic response and consider TDM to assure dosage adequacy in patients weighing >90 kg. Key: ARV = antiretroviral; ART = antiretroviral therapy; BIC = bictegravir; COBI = cobicistat; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FTC = emtricitabine; MVC = maraviroc; PI = protease inhibitor; PK = pharmacokinetic; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; TAF = tenofovir alafenamide; TB = tuberculosis; TDM = therapeutic drug monitoring

Tables

Table 3. Dosing Recommendations for Anti-TB Drugs for Treatment of Active Drug Sensitive TB

Table 3. Dosing Recommendations for Anti-TB Drugs for Treatment of Active Drug Sensitive TB
TB Drug	ARV Drugs	Daily Dose
Isoniazid	All ARVs	5 mg/kg (usual dose 300 mg)
Rifampin^a,b Note: DTG, RAL, and MVC doses need to be adjusted when used with rifampin	With HIV PIs, DOR, ETR, RPV, BIC, or EVG/c	Not recommended
	With TAF	Use with caution^c at dose indicated below
	With other ARV drugs	10 mg/kg (usual dose 600 mg)
Rifabutin^a Note: DOR and RPV doses need to be adjusted when used with rifabutin	With PI with COBI, TAF, BIC, or EVG/c - containing regimens	Not recommended
	With DTG, RAL, EFV, DOR, RPV	5 mg/kg (usual dose 300 mg)
	With HIV PIs with RTV	150 mg^d
	With EFV	450–600 mg
Pyrazinamide	All ARVs	Weight-Based Dosing Weighing 40–55 kg: 1,000 mg (18.2–25.0 mg/kg) Weighing 56–75 kg: 1,500 mg (20.0–26.8 mg/kg) Weighing 76–90 kg: 2,000 mg (22.2–26.3 mg/kg) Weighing >90 kg: 2,000 mg^e
Ethambutol	All ARVs	Weight-Based Dosing Weighing 40–55 kg: 800 mg (14.5–20.0 mg/kg) Weighing 56–75 kg: 1,200 mg (16.0–21.4 mg/kg) Weighing 76-90 kg: 1,600 mg (17.8–21.1 mg/kg) Weighing >90 kg: 1,600 mg^e
^a For more detailed guidelines on use of different ARV drugs with rifamycin, clinicians should refer to the Drug-Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines ^b Higher doses may be needed in the treatment of TB meningitis. Expert consultation is advised. ^c This combination has not been tested in patients to confirm PK and virologic efficacy among patients taking full dose ART and TB regimens ^d Acquired rifamycin resistance has been reported in patients with inadequate rifabutin levels while on 150 mg twice weekly dosing together with RTV-boosted PIs. May consider TDM when rifabutin is used with an RTV-boosted PI and adjust dose accordingly. ^e Monitor for therapeutic response and consider TDM to assure dosage adequacy in patients weighing >90 kg. Key: ARV = antiretroviral; ART = antiretroviral therapy; BIC = bictegravir; COBI = cobicistat; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FTC = emtricitabine; MVC = maraviroc; PI = protease inhibitor; PK = pharmacokinetic; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; TAF = tenofovir alafenamide; TB = tuberculosis; TDM = therapeutic drug monitoring

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