When disseminated Mycobacterium kansasii infection occurs in a patient living with HIV, managing the regimen requires accounting for significant drug interactions that do not arise in HIV-negative individuals. The standard treatment backbone cannot simply be applied without modification.
This protocol addresses patients presenting with Mycobacterium kansasii infection in the context of HIV co-infection. In this population, rifampin — the cornerstone of standard M. kansasii treatment — presents a critical challenge: it substantially increases the hepatic metabolism of protease inhibitors commonly used in HIV management, potentially undermining antiretroviral efficacy.
For HIV-co-infected patients, the approach involves substituting a rifamycin agent that has less impact on hepatic drug metabolism, preserving the effectiveness of concurrent antiretroviral therapy.
DOI: 10.3389/fmicb.2018.02271
RIF is currently the cornerstone for the therapy of M. kansasii infection, but in patients co-infected with HIV, RIF presents a problem since it increases the hepatic metabolism of protease inhibitors, often used for the treatment of HIV infection.
Rifabutin (RBT) has less effect on the hepatic metabolism, therefore, it is often used as an alternative to RIF in HIV-infected patients.
Rifapentine (RPT) is an alternative to RIF or RBT.
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