ATS GUIDELINES Bundle

15 Table 3. Select Antiretroviral and Non–rifamycin-based Anti-tuberculosis Drug Overlapping Toxicities and Potential Adverse Drug-drug Interactions Potential overlapping toxicities and drug-drug interactions Antiretroviral drugs Non-Rifamycin TB drugs Skin rash Nevirapine (higher risk in patients with elevated CD4 cell counts), efavirenz, etravirine, rilpivirine; Any protease inhibitor (esp. those containing sulfonamide moiety: e.g., darunavir); abacavir (hypersensitive reaction a risk in patient who are HLA-B5701 positive); raltegravir All TB drugs Note skin pigmentation with clofazimine use ioacetazone should be avoided in people with HIV, because of an elevated risk of a severe adverse skin reaction. Dysglycemia Lopinavir/ritonavir, ritonavir, stavudine, zidovudine Ethionamide, p-aminosalicylic acid, fluoroquinolones, linezolid Myelosuppression/ cytopenias Zidovudine Linezolid Lactic acidosis Stavudine, zidovudine Linezolid Note: Saquinavir, indinavir, fosamprenavir, tipranavir, and didanosine are older antiretroviral drugs that are rarely used in the United States. ey do have many of the adverse interactions listed above with select TB drugs, and clinicians considering the use of these agents should therefore consult with an expert. a Fluoroquinolones include ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin and moxifloxacin b Use with caution in patients with underlying cardiac dysrhythmia c Tenofovir alafenamide (TAF) – a prodrug of tenofovir and FDA-approved in 2015. It is associated with decreased incidence of osteoporosis and nephrotoxicity compared to tenofovir disoproxil fumarate (TDF) through achieving higher intra-cellular drug concentrations with a lower dose administered d Increases in serum creatinine via decrease renal tubular creatinine excretion are commonly seen with cobicistat and dolute-gravir usage. is is not a toxicity. e Indirect hyperbilirubinemia is expected with atazanavir and indinavir. is is not a toxicity. (cont'd)

• Cover