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A pilot study of immune activation and rifampin absorption in HIV-infected patients without tuberculosis infection
A short report
Vinnard, C., Manley, I., Scott, B., Bernui, M., Adams, J. W. I., Varghese, S., Zenter, I., & Kutzler, M. (2017). A pilot study of immune activation and rifampin absorption in HIV-infected patients without tuberculosis infection: A short report. Tuberculosis Research and Treatment, 2017, Article 2140974. https://doi.org/10.1155/2017/2140974
Background: Rifampin malabsorption is frequently observed in tuberculosis patients coinfected with human immunodeficiency virus (HIV) but cannot be predicted by patient factors such as CD4+ T cell count or HIV viral load.
Methods: We sought to describe the relationship between HIV-associated immune activation, measures of gut absorptive capacity and permeability, and rifampin pharmacokinetic parameters in a pilot study of 6 HIV-infected, tuberculosis-uninfected patients who were naïve to antiretroviral therapy.
Results: The median rifampin area under the concentration-versus-time curve during the 8-hour observation period was 42.8 mg·hr/L (range: 21.2 to 57.6), with a median peak concentration of 10.1 mg/L (range: 5.3 to 12.5). We observed delayed rifampin absorption, with a time to maximum concentration greater than 2 hours, in 2 of 6 participants. There was a trend towards increased plasma concentrations of sCD14, a marker of monocyte activation in response to bacterial translocation, among participants with delayed rifampin absorption compared to participants with rapid absorption (p = 0.06).
Conclusions: Delayed rifampin absorption may be associated with elevated markers of bacterial translocation among HIV-infected individuals naïve to antiretroviral therapy. This trial is registered with NCT01845298.
