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Tuberculosis — SCE Infectious Diseases MCQ

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HardTuberculosisTuberculosisSCE Infectious Diseases

A 29-year-old man with well-controlled HIV on Bictegravir/Emtricitabine/Tenofovir AF develops active pulmonary TB. GeneXpert shows no Rifampicin resistance. What is the key pharmacological consideration when co-administering Rifampicin with his ART?

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Correct answer: E — Rifampicin reduces Bictegravir levels; switch to a Dolutegravir-based regimen with dose adjustment

Rifampicin is a potent CYP3A4 and UGT1A1 inducer that dramatically reduces Bictegravir levels, making co-administration contraindicated. The recommended approach is to switch to Dolutegravir, which can be co-administered with Rifampicin at an increased dose of 50 mg BD (instead of 50 mg OD). Alternatively, Rifabutin can be used instead of Rifampicin with fewer drug interactions, but Rifampicin is preferred in resource-limited settings and is standard in NICE TB guidelines.

Reference: BHIVA 2022 – TB/HIV co-infection; BNF 2024 – Drug interactions: Rifampicin