Double-dose lopinavir-ritonavir in combination with rifampicin-based anti-tuberculosis treatment in South Africa

H. Sunpath, P. Winternheimer, S. Cohen, I. Tennant, N. Chelin, R. T. Gandhi, R. A. Murphy

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: The optimal treatment for tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients in resource-poor settings receiving lopinavir-ritonavir (LPV/r) based second-line antiretroviral therapy (ART) has yet to be determined. In South Africa, clinicians are advised to use 'double-dose' LPV/r dosed at 800 mg/200 mg twice daily during antituberculosis treatment. METHODOLOGY AND PRINCIPLE FINDINGS: We conducted a retrospective study of HIV-infected patients who received ≥2 months of double-dose LPV/r-based ART during concomitant rifampicin-containing antituberculosis treatment. We used standard definitions for TB and HIV outcomes; virological failure was defined as a viral load >1000 copies/ml. During co-administration, gastro-intestinal toxicity occurred in 9/25 (36%) patients, a symptomatic rise in aspartate aminotransferase or alanine aminotransferase of any grade was noted in 3 (12%), with two Grade 3 events, and 3 (12%) patients required treatment discontinuation. Outcomes were favourable, with 20/25 (80%) patients achieving TB treatment success and virological failure observed among 3 (12%) patients during co-administration. CONCLUSION: We found the use of double-dose LPV/r during simultaneous standard anti-tuberculosis treatment to be an effective and reasonably well tolerated interim strategy.

Original languageEnglish (US)
Pages (from-to)689-693+i
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
StatePublished - Jun 1 2014
Externally publishedYes


  • Co-infection
  • Second-line ART
  • Toxicity

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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