Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya31650Research ArticleThe efficacy and safety of a therapy regimen including raltegravir and a fixed dose combination of lamivudine and abacavir in previously rifabutin-treated patients with tuberculosis and HIV infectionKravchenkoA Vkravtchenko@hivrussia.netZiminaV N-PopovaA A-DeulinaM O-KanestriV G-IvanovaÉ S-IakovlevA A-PokrovskiĭV V-151120148611344110042020Copyright © 2014, Consilium Medicum2014AIM. To evaluate the efficiency and safety of using raltegravir (RAL) twice daily in conjunction with a once-daily fixed dose combination of abacavir (ABC)/lamivudine (3TC) in patients with HIV infection and active tuberculosis who have not previously received antiretroviral therapy (ART) and have taken rifabutin as antituberculosis therapy (ATT). MATERIALS AND METHODS. The efficiency of ART was evaluated in 28 patients from a change in HIV RNA levels and from an increase in CD4+ lymphocyte counts during 48-week treatment that had been completed by 15 (53.6%) patients. The main reason for therapy discontinuation was that the patients returned to the use psychoactive agents. RESULTS. After 24 and 48 weeks of ART, the level of HIV RNA reached the undetectable values (less than 50 copies/ml) in 81.25 and 75% of the patients, respectively (according to an analysis including the patients who had completed the study in conformity with the requirements of the protocol). In only 2 patients, the virological therapy proved to be ineffective, which was likely to be associated with noncompliance with drug therapy. Following 24- and 48-week therapy, the increase in median CD4+ lymphocyte counts was 70 and 208.5 per µl, respectively. The concurrent use of ART and ATT caused positive changes in the lung skiagraphic pattern in 92.9% of the patients and complete resolution of lung tissue infiltration in 71.4%. Mixed infection ended in a fatal outcome caused by a progressive tuberculous process in 3 (10.7%) patients, in 2 of them within the first 8 weeks of treatment. The concomitant use of ATT including rifabutin and an ART (RAL + ABC/3TC) regimen was safe since one patient was noted to have a RAL-related adverse event (AE) (an allergic reaction) and caused the patient to discontinue therapy. ATT was not discontinued because of AE in any case. CONCLUSION. The ART regimen containing RAL and a fixed dose combination of ABC/3TC for adult patients with tuberculosis concurrent with HIV infection who are on combined therapy using rifabutin for tuberculosis may be recommended for the treatment of this category of patients.HIV infectiontuberculosisantiretroviral therapyraltegravirabacavir/lamivudinerifabutinВИЧ-инфекциятуберкулезантиретровирусная терапияралтегравирабакавир/ламивудинрифабутин[Зимина В.Н., Кравченко А.В., Батыров Ф.А. и др. Комбинированная противотуберкулезная и антиретровирусная терапия у больных туберкулезом в сочетании с ВИЧ-инфекцией: эффективность и переносимость. Туб и бол легких 2012; 2: 37-43.][Кравченко А.В., Зимина В.Н. Антиретровирусная терапия у больных ВИЧ-инфекцией и туберкулезом. Инфекц бол: новости, мнения, обучение 2012; 1: 15-21.][Пантелеев А.М., Рахманова А.Г. Антиретровирусная терапия у ВИЧ-инфицированных, больных туберкулезом. Инфекционные болезни-2009: альманах. СПб 2009: 150-153.][Канестри В.Г., Зимина В.Н., Кравченко А.В. и др. Сочетанная терапия ВИЧ-инфекции и туберкулеза: анализ безопасности и переносимости. Инфекц бол 2012; 3: 5-9.][Зимина В.Н. Совершенствование диагностики и эффективность лечения туберкулеза у больных ВИЧ-инфекцией при различной степени иммуносупрессии: Автореф. дис. ... д-ра мед. наук. М 2012; 44.][Sathia L., Obiorah I., Taylor G. et al. Concomitant use of nonnucleoside analogue reverse transcriptase inhibitors and rifampicin in TB/HIV type 1-coinfected patients. Aids Res Hum Retrovirus 2008; 2 (7): 897-901.][Покровский В.В., Юрин О.Г., Кравченко А.В. и др. Протоколы диспансерного наблюдения и лечения больных ВИЧ-инфекцией. Эпидемиол и инфекц бол 2013; 6: 1-32.][Обследование и антиретровирусная терапия у взрослых и подростков. Клинический протокол для Европейского региона ВОЗ (обновленная версия 2012 г.) ВОЗ, Копенгаген 2012; 91.][Guidelines for the Clinical Management and Treatment of HIV-infected Adults in Europe (Version 7,0; November, 2013). European AIDS Clinical Society (http://www.europeanaidsclinicalsociety.org).][Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, May 7, 2013 (http://AIDSinfo.nih.gov).][Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents //Developed by the Panel on Clinical Practices for Treatment of HIV Infection convened by the Department of Health and Human Services (DHHS) May 1, 2014 (http://AIDSinfo.nih.gov).][Wenning L.A., Hanley W.D., Brainard D.M. et al. Effect of rifampin, a potent inducer of drug-metabolizing enzymes, on the pharmacokinetics of raltegravir. Antimicrob Agents Chemother 2009; 53: 2852-2856.][Burgera D.M., Magis-Escurrac C., van den Berkd G.E.L., Gelincke L.B.S. Фармакокинетика удвоенной дозы ралтегравира у двух пациентов с ВИЧ-инфекцией и туберкулезом. AIDS (русское издание) 2011; 4 (2): 229-231.][Mena М., Va´zquez P., Castro A. et al. Clinical experience of raltegravir containing regimens in HIV-infected patients during rifampicin-containing treatment of tuberculosis. J Antimicrob Chemother 2011; 66: 951-952.][Grinsztejn B., De Castro N., Arnold V. et al. A randomized multicenter open-label trial to estimate the efficacy and safety of two doses of raltegravir (RAL) to efavirenz (EFV) for the treatment of HIV-TB co-infected patients: results of the ANRS 12 180 Reflate TB trial. Program and abstracts of the XIX International AIDS Conference; July 22-27, 2012; Washington, DC. Abstract THLBB01.][Козлов С.Н., Страчунский Л.С. Современная антимикробная химиотерапия: Руководство для врачей. М: МИА 2009; 448.][Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events/ Versoin 1.0, December 2004; Clarification August 2009 http://rsc.techres.com/Document/safetyandpharmacovigilance/Table_for_Grading_Severity_of_Adult_Pediatric_Adverse_Events.pdf]