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Urine levels of rifampicin & isoniazid in asymptomatic HIV-positive individuals
Reprint requests: Dr Soumya Swaminathan, Deputy Director (Sr. Gr.) & Head, HIV/AIDS Division, Tuberculosis Research Centre, Mayor V.R. Ramanathan Road, Chetput, Chennai 600031, India e-mail: doctorsoumya@yahoo.com
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Received: ,
Abstract
Background & objectives:
AIDS and its associated gastrointestinal complications may impair the absorption of anti-tuberculosis (TB) drugs. Impaired absorption of anti-TB drugs could lead to low drug exposure, which might contribute to acquired drug resistance and reduced effectiveness of anti-TB treatment. The aim of this study was to obtain information on the status of absorption of rifampicin (RMP) and isoniazid (INH) in asymptomatic HIV- positive individuals, who are less immunocompromised. The D-xylose absorption test was also carried out to assess the absorptive capacity of intestive.
Methods:
The absorption of RMP, INH and D-xylose was studied in 15 asymptomatic HIV- positive individuals with CD4 cell counts > 350 cells/mm3 and 16 healthy volunteers, after oral administration of single doses of RMP (450 mg), INH (300 mg) and D-xylose (5 g). Urine was collected up to 8 h after drugadministration. Percentage dose of the drugs and their metabolites and D-xylose excreted in urine were calculated.
Results:
A significant reduction in the urinary excretion of INH and D-xylose in HIV-positive persons compared to healthy volunteers was observed. The per cent dose of RMP and its metabolite, desacetyl RMP was also lower in HIV-positive persons compared to healthy volunteers, but this difference was not statistically significant.
Interpretation & conclusion:
Decreased urinary excretion of D-xylose and INH are suggestive of intestinal malabsorption in HIV-positive individuals. HIV infection could cause malabsorption of anti-TB drugs even at an early stage of the disease. The clinical implications of these findings need to be confirmed in larger studies.
