In the case of an HIV patient on a DR-TB regimen containing Bedaquiline, which anti-retroviral drug should be avoided?

Bedaquiline is a medication used in the treatment of multidrug-resistant tuberculosis (DR-TB). It has specific drug interactions that are crucial to consider, especially in patients who are also on antiretroviral therapy for HIV.

Efavirenz is known to induce the metabolism of certain medications, which can decrease their effectiveness. In the case of Bedaquiline, efavirenz can reduce its plasma concentrations due to its stimulation of certain liver enzymes (CYP450 system). This induction can lead to inadequate levels of Bedaquiline in the body, potentially compromising the treatment of DR-TB. As a result, combining efavirenz with a regimen that includes Bedaquiline is not recommended to ensure that the tuberculosis treatment remains effective.

On the other hand, Nevirapine and Dolutegravir do not possess the same interaction profile as efavirenz. Nevirapine, while also an antiretroviral, has a different mechanism of metabolism and is less likely to significantly affect the levels of Bedaquiline. Dolutegravir, a newer generation antiretroviral, is preferred in many settings and’s use does not have the same concerns regarding drug interactions with Bedaquiline as efavirenz