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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Nutritional supplementation increases rifampin exposure among tuberculosis patients coinfected with HIV
Antimicrobial Agents and Chemotherapy, Volume 58, No. 6, Year 2014
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Description
Nutritional supplementation to tuberculosis (TB) patients has been associated with increased weight and reduced mortality, but its effect on the pharmacokinetics of first-line anti-TB drugs is unknown. A cohort of 100 TB patients (58 men; median age, 35 [interquartile range {IQR}, 29 to 40] years, and median body mass index [BMI], 18.8 [17.3 to 19.9] kg/m2) were randomized to receive nutritional supplementation during the intensive phase of TB treatment. Rifampin plasma concentrations were determined after 1 week and 2 months of treatment. The effects of nutritional supplementation, HIV, time on treatment, body weight, and SLCO1B1 rs4149032 genotype were examined using a population pharmacokinetic model. The model adjusted for body size via allometric scaling, accounted for clearance autoinduction, and detected an increase in bioavailability (+14%) for the patients in the continuation phase. HIV coinfection in patients not receiving the supplementation was found to decrease bioavailability by 21.8%, with a median maximum concentration of drug in serum (Cmax) and area under the concentration-time curve from 0 to 24 h (AUC0-24) of 5.6 μg/ml and 28.6 μg.h/ml, respectively. HIV-coinfected patients on nutritional supplementation achieved higher C max and AUC0-24 values of 6.4 μg/ml and 31.6 μg.h/ml, respectively, and only 13.3% bioavailability reduction. No effect of the SLCO1B1 rs4149032 genotype was observed. In conclusion, nutritional supplementation during the first 2 months of TB treatment reduces the decrease in rifampin exposure observed in HIV-coinfected patients but does not affect exposure in HIV-uninfected patients. If confirmed in other studies, the use of defined nutritional supplementation in HIV-coinfected TB patients should be considered in TB control programs. (This study has the controlled trial registration number ISRCTN 16552219. © 2014, American Society for Microbiology.
Authors & Co-Authors
Jeremiah, Kidola
Denmark, Odense
Odense Universitetshospital
Tanzania, Tanga
National Institute for Medical Research Tanga
Denti, Paolo
South Africa, Cape Town
University of Cape Town
Chigutsa, Emmanuel
South Africa, Cape Town
University of Cape Town
Faurholt-Jepsen, Daniel
Denmark, Copenhagen
Københavns Universitet
PrayGod, George
Tanzania, Tanga
National Institute for Medical Research Tanga
Range, Nyagosya Segere
Tanzania, Tanga
National Institute for Medical Research Tanga
Castel, Sandra A.
South Africa, Cape Town
University of Cape Town
Wiesner, L. D.
South Africa, Cape Town
University of Cape Town
Hagen, Christian Munch
Denmark, Copenhagen
Statens Serum Institut
Christiansen, Michael
Denmark, Copenhagen
Statens Serum Institut
Changalucha, John M.
Tanzania, Tanga
National Institute for Medical Research Tanga
McIlleron, Helen Margaret
South Africa, Cape Town
University of Cape Town
Friis, Henrik M.U.
Denmark, Copenhagen
Københavns Universitet
Andersen, Aase Bengaard
Denmark, Odense
Odense Universitetshospital
Statistics
Citations: 58
Authors: 14
Affiliations: 5
Identifiers
Doi:
10.1128/AAC.02307-13
ISSN:
00664804
e-ISSN:
10986596
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Participants Gender
Male