Lopinavir–ritonavir super-boosting in young HIV-infected children on rifampicin-based tuberculosis therapy compared with lopinavir–ritonavir without rifampicin: a pharmacokinetic modelling and clinical study

by Rabie H, Denti P, Lee J, Masango M, Coovadia A, Pillay S, Liberty A, Simon F, McIlleron H, Cotton MF, Lallemant M. The Lancet HIV 2019, 6(1):e32-e42. doi: 10.1016/S2352-3018(18)30293-5

Summary:  The tuberculosis treatment rifampicin reduces the concentration of the HIV treatment lopinavir in co-treated patients. In order to overcome this drug-drug interaction in young children, the authors describe a study into to impact of ‘superboosting’, adding ritonavir to co-formulated lopinavir–ritonavir. Lopinavir exposure when super-boosting with ritonavir during rifampicin-based tuberculosis treatment was found to be non-inferior to lopinavir exposure in the absence of rifampicin treatment. Superboosting was found to be safe and effective, although its application in the field is limited by poor acceptability. Access to better adapted solid formulations is likely to facilitate public health implementation of this strategy.

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