HIV-TB Coinfection in Children and Pregnant Women: Pharmacogenomic and Drug Interaction Challenges
This review addresses the underrepresentation of children and pregnant women in HIV-TB cotreatment trials and the resulting knowledge gaps in pharmacokinetics, drug-drug interactions, and pharmacogenomic dosing. It highlights how CYP and transporter polymorphisms can alter rifampicin-antiretroviral interactions in ways that differ by age and pregnancy status. The paper calls for inclusion of special populations in PGx research to enable safer, evidence-based cotreatment regimens.
The original study
State-of-the-Art Review of HIV-TB Coinfection in Special Populations.
- Authors
- Weld ED, Dooley KE
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Review
- PMID
- 30137652
Original abstract
Children and pregnant and postpartum women experience an undue burden of HIV-associated tuberculosis (TB), but data are lacking on key aspects of their complex management. Often excluded from clinical trials, they are left with limited options for HIV-TB cotreatment. This review will focus on pharmacologic aspects of the treatment of HIV-TB coinfection in the special populations of children and pregnant and postpartum women. Pharmacogenomic considerations, rational dosing, drug-drug interactions, safety, immune reconstitution inflammatory syndrome, and ethical and policy aspects of the inclusion of special populations in research will be surveyed. Considerations related to the treatment of both HIV-associated TB disease and HIV-associated latent TB infection will be summarized. Relevant knowledge gaps and research priorities in special populations will be outlined.