Which drugs should be avoided when co-administering with 3HP or 3HR or 4R LTBI regimen in individuals with HIV?

The co-administration of 3HP (once-weekly isoniazid and rifapentine), 3HR (daily isoniazid and rifampin), or 4R (daily rifampin) regimens for latent tuberculosis infection (LTBI) in individuals with HIV necessitates careful consideration of drug interactions. In particular, Nevirapine and Protease inhibitors both pose significant risks when used in conjunction with these LTBI treatments.

Nevirapine, as a non-nucleoside reverse transcriptase inhibitor (NNRTI), is known to induce hepatic enzymes, which can lead to decreased levels of rifapentine and rifampin in the body. This can compromise the efficacy of the tuberculosis treatment, as these medications are crucial for effectively managing both LTBI and active tuberculosis.

Protease inhibitors, although primarily focused on blocking HIV replication, also have significant interactions when paired with rifamycins like rifapentine and rifampin. They can have varied effects depending on the specific protease inhibitor, but the potential for altered drug levels can put patients at risk for inadequate HIV control, reduced efficacy of LTBI treatment, or increased side effects.

By avoiding both Nevirapine and Protease inhibitors in patients