Potential overlapping toxicities and drug–drug interactions | Antiretroviral drugs | Non-rifamycin TB drugs |
Arrhythmias, QT interval prolongation | Lopinavir/ritonavir, efavirenz Note PR interval prolongation* with atazanavir, lopinavir/ritonavir | Fluoroquinolones¶, bedaquiline, delamanid, clofazimine |
Hepatic cytochrome P450 enzyme system metabolism | Induce CYP P450 metabolism: efavirenz, etravirine, and nevirapine Impede CYP P450 metabolism: protease inhibitors, cobicistat | Bedaquiline, delamanid |
Nephrotoxicity | Tenofovir,Δ atazanavir Isolated creatinine elevation◊: cobicistat, dolutegravir | Aminoglycosides, capreomycin |
Mental health changes (depression, psychosis, dizziness, etc.) | Efavirenz, rilpivirine; dolutegravir, elvitegravir, raltegravir | Cycloserine, isoniazid, ethionamide, fluoroquinolones† |
Peripheral neuropathy | Stavudine, zidovudine | Aminoglycosides, capreomycin, linezolid, isoniazid, ethionamide, cycloserine, fluoroquinolones¶ |
Hepatotoxicity | Lactic acidosis with hepatic steatosis higher risk with stavudine, zidovudine; protease inhibitors; nevirapine (higher risk in patients with elevated CD4 cell counts); less common with efavirenz, etravirine and rilpivirine; maraviroc Indirect hyperbilirubinemia§: atazanavir | Isoniazid, pyrazinamide, ethionamide, p-aminosalicylic acid, clofazimine |
Skin rash | Nevirapine (higher risk in patients with elevated CD4 cell counts), efavirenz, etravirine, rilpivirine Any protease inhibitor (especially those containing sulfonamide moiety: eg, darunavir); abacavir (hypersensitive reaction a risk in patient who are HLA-B5701 positive); raltegravir | All TB drugs Note skin pigmentation with clofazimine use Thioacetazone should be avoided in people with HIV, because of an elevated risk of a severe adverse skin reaction |
Dysglycemia | Lopinavir/ritonavir, ritonavir, stavudine, zidovudine | Ethionamide, p-aminosalicylic acid, fluoroquinolones, linezolid |
Myelosuppression/cytopenias | Zidovudine | Linezolid |
Lactic acidosis | Stavudine, zidovudine | Linezolid |
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