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We hypothesized that compared to outpatients, there would be lower anti\u2010TB drug exposure in hospitalized HIV\u2010TB patients, and amongst hospitalized patients exposure would be lower in patients who die or have high lactate (a sepsis marker).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed pharmacokinetic sampling in hospitalized HIV\u2010TB patients and outpatients. Plasma rifampicin, isoniazid and pyrazinamide concentrations were measured in samples collected predose and at 1, 2.5, 4, 6 and 8 hours on the third day of standard anti\u2010TB therapy. Twelve\u2010week mortality was ascertained for inpatients. Noncompartmental pharmacokinetic analysis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pharmacokinetic data were collected in 59 hospitalized HIV\u2010TB patients and 48 outpatients. Inpatient 12\u2010week mortality was 11\/59 (19%). Rifampicin, isoniazid and pyrazinamide exposure was similar between hospitalized and outpatients (maximum concentration [C<jats:sub>max<\/jats:sub>]: 7.4 <jats:italic>vs<\/jats:italic> 8.3 \u03bcg mL<jats:sup>\u20131<\/jats:sup>, <jats:italic>P =<\/jats:italic> .223; 3.6 <jats:italic>vs<\/jats:italic> 3.5 \u03bcg mL<jats:sup>\u20131<\/jats:sup>, <jats:italic>P =<\/jats:italic> .569; 50.1 <jats:italic>vs<\/jats:italic> 46.8 \u03bcg mL<jats:sup>\u20131<\/jats:sup>, <jats:italic>P =<\/jats:italic> .081; area under the concentration\u2013time curve from 0 to 8 hours: 41.0 <jats:italic>vs<\/jats:italic> 43.8 mg h L<jats:sup>\u20131<\/jats:sup>, <jats:italic>P<\/jats:italic> = 0.290; 13.5 <jats:italic>vs<\/jats:italic> 12.4 mg h L<jats:sup>\u20131<\/jats:sup>, <jats:italic>P =<\/jats:italic> .630; 316.5 <jats:italic>vs<\/jats:italic> 292.2 mg h L<jats:sup>\u20131<\/jats:sup>, <jats:italic>P =<\/jats:italic> .164, respectively) and not lower in inpatients who died. Rifampicin and isoniazid C<jats:sub>max<\/jats:sub> were below recommended ranges in 61% and 39% of inpatients and 44% and 35% of outpatients. Rifampicin exposure was higher in patients with lactate &gt;2.2 mmol L<jats:sup>\u20131<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Mortality in hospitalized HIV\u2010TB patients was high. Early anti\u2010TB drug exposure was similar to outpatients and not lower in inpatients who died. Rifampicin and isoniazid C<jats:sub>max<\/jats:sub> were suboptimal in 61% and 39% of inpatients and rifampicin exposure was higher in patients with high lactate. Treatment strategies need to be optimized to improve survival.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.14207","type":"journal-article","created":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T07:07:15Z","timestamp":1578467235000},"page":"966-978","source":"Crossref","is-referenced-by-count":10,"title":["Early antituberculosis drug exposure in hospitalized patients with human immunodeficiency virus\u2010associated tuberculosis"],"prefix":"10.1111","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8329-6158","authenticated-orcid":false,"given":"Charlotte","family":"Schutz","sequence":"first","affiliation":[{"name":"Wellcome Centre for Infectious Diseases Research in Africa Institute of Infectious Disease and Molecular Medicine, University of Cape Town  Observatory South Africa"},{"name":"Department of Medicine University of Cape Town  Observatory South 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