Dosing rifabutin and lopinavir/r – sub-optimal rifabutin levels reported in five patients dosed according to current guidelines

Simon Collins, HIV i-Base

Hasanin Khachi and colleagues from Barts and the London Trust reported drug levels of rifabutin in five patients concurrently using lopinavir/r-based ARV regimens. Following current guidelines (BHIVA, CDC), rifabutin dose was reduced from 300mg daily to 150mg three times a week, in five patients, and levels were measured using standard therapeutic drug monitoring after two weeks.

Rifabutin levels for all five patients were sub-therapeutic, (see Table 1) with one patient deteriorating clinically.

The researchers concluded that this data suggests current BHIVA and CDC guidelines result in sub-therapeutic rifabutin levels and that further formal investigations are required to establish the clinical significance of this, and determine the optimum dosing regimes for Kaletra and rifabutin in co-infected patients.

Table 1: Rifabutin levels at week 2

Patient Rifabution 4h post-level (mg/L) Kaletra trough level (ng/mL)
1 0.16 9352*
2 0.33 1030*
3 0.17 18 035*
4 <0.10 1549*
5 0.16 7910*

Rifabutin post-dose: 0.50-­1.0 mg/L

Kaletra trough level: for wild type virus: 1000 ng/L

*Experienced patients: 8000 ng/L


Khachi H, Ladenheim D, Orkin C et al. Pharmacokinetic interactions between rifabutin and lopinavir/ritonavir in HIV-infected patients with mycobacterial co-infection. Oral abstract O12.

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