Outcomes of nevirapine- and efavirenz-based antiretroviral therapy when coadministered with rifampicin-based antitubercular therapy.

Results The analysis included 2035 individuals who started antiretroviral therapy with efavirenz (1074 with concurrent tuberculosis) and 1935 with nevirapine (209 with concurrent tuberculosis). There were no differences in time to death or substitution of either antiretroviral drug for toxicity with and without concurrent tuberculosis. Patients starting nevirapine with concurrent tuberculosis were at a higher risk of elevated viral load most notably at 6 months (16.3%; 95% confidence interval [CI], 10.6%-23.5%) than those without tuberculosis (8.3%; 95% CI, 6.7%-10.0%; adjusted odds ratio [OR], 2.1; 95% CI,1.2-3.4;andinthecombinedestimate,adjustedOR,1.7;95%CI,1.2-2.6).Inthetimeto-event analysis of confirmed virological failure (2 consecutive values of 5000 copies/ mL), patients starting nevirapine with concurrent tuberculosis developed virological failure sooner (adjusted hazard ratio [HR] 2.2; 95% CI, 1.3-3.7). There were no differences betweenpatientsstartingefavirenzwithandwithoutconcurrenttuberculosis(adjustedOR, 1.1;95%CI,0.8-1.5[combinedestimate]andadjustedHR,1.1;95%CI,0.6-2.0,respectively). There was no difference in time to virological rebound in patients free of tuberculosisandthosedevelopingtuberculosisduringfollow-upwhiletakingnevirapine(adjusted HR, 1.0; 95% CI, 0.5-2.0) or efavirenz (adjusted HR, 0.8; 95% CI, 0.4-1.7). Conclusion In this cohort study, virological outcomes were inferior when nevirapinebased antiretroviral therapy was commenced while taking antitubercular treatment (vs without concurrent tuberculosis) but comparable when starting efavirenz-based antiretroviral therapy (vs without concurrent tuberculosis) or when tuberculosis developed while taking established nevirapine- or efavirenz-based therapies.