{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T02:30:40Z","timestamp":1784341840049,"version":"3.55.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000200","name":"US Agency for International Development","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000200","name":"USAID","doi-asserted-by":"publisher","award":["AID-OAA-A-15\u201300069 OPTIMIZE"],"award-info":[{"award-number":["AID-OAA-A-15\u201300069 OPTIMIZE"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Cape Town and the Medicines Patent Pool"},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Darunavir\/ritonavir is better tolerated than lopinavir\/ritonavir and has a higher genetic barrier to resistance. Co-administration with rifampicin has been contraindicated as a significant reduction in darunavir exposure is expected. This is a barrier to darunavir\/ritonavir use where TB is endemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the safety and pharmacokinetic profile of adjusted doses of darunavir\/ritonavir with rifampicin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Virally suppressed participants on second-line lopinavir\/ritonavir-based ART were switched to darunavir\/ritonavir 800\/100\u2009mg q24h. In sequence: rifampicin was added; the dose of ritonavir was escalated; and darunavir was increased (darunavir\/ritonavir 1600\/200\u2009mg q24h and 800\/100\u2009mg q12h were given in randomized sequence with rifampicin). Darunavir plasma concentrations were measured on the seventh\/last day of each treatment period. To prevent viral rebound, dolutegravir (50\u2009mg q12h) was added during rifampicin administration and for 1\u2009week thereafter. Clinical events, ALT and bilirubin were monitored every 2\u20133\u2009days during rifampicin administration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 17\/28 participants started study treatment. Six (35.3%) were withdrawn for symptomatic hepatitis with severe ALT elevations, developing after 9\u201311\u2009days of rifampicin and 2\u20134\u2009days of ritonavir 200\u2009mg. The study was stopped prematurely due to this high rate of hepatotoxicity. Only four participants completed the study. All hepatotoxicity resolved on withdrawal of study treatment. All participants were successfully re-established on their lopinavir\/ritonavir-based regimen. After doubling the darunavir\/ritonavir doses on rifampicin, darunavir pre-dose concentrations approached those on standard doses without rifampicin for q12h doses, but not for q24h doses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adjusted doses of darunavir\/ritonavir with rifampicin had unacceptable risk of hepatotoxicity. Darunavir trough concentrations were markedly reduced with the daily adjusted dose.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkz522","type":"journal-article","created":{"date-parts":[[2019,12,9]],"date-time":"2019-12-09T20:09:41Z","timestamp":1575922181000},"page":"1019-1025","source":"Crossref","is-referenced-by-count":17,"title":["Pharmacokinetic profile and safety of adjusted doses of darunavir\/ritonavir with rifampicin in people living with HIV"],"prefix":"10.1093","volume":"75","author":[{"given":"Ismaeel","family":"Ebrahim","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Maartens","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa"},{"name":"Wellcome Centre for Infectious 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