Does TB treatment affect HIV medications in women?

Question

Hello doctor,

I am a 38-year-old woman living with HIV for the past six years. I have been on regular antiretroviral therapy (TLD regimen - Tenofovir, Lamivudine, and Dolutegravir) and was doing well until recently. My last reports showed a CD4 count of 180 cells/mm³, and my viral load was undetectable three months ago.

For the past few weeks, I have been having a persistent cough, significant weight loss (around 13.2 pounds), and night sweats. A chest X-ray showed upper lobe infiltrates, and my sputum test was positive for acid-fast bacilli. I have now been diagnosed with pulmonary tuberculosis and started on the standard four-drug TB treatment (HRZE).

I am worried about drug interactions, especially between Rifampicin and Dolutegravir. Please let me know the following:

Do I need to change the dose of my HIV medicines or switch to a different regimen?
Since starting TB treatment, I am also experiencing nausea and poor appetite. How can I manage these side effects while continuing both treatments properly?
Will having TB along with HIV affect my long-term immune recovery?
Also, since my CD4 count is low, am I at a higher risk of developing IRIS (immune reconstitution inflammatory syndrome)?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

Given that you have pulmonary tuberculosis (TB in the lungs) along with HIV (human immunodeficiency virus, a virus that weakens the immune system) and a relatively low CD4 or cluster of differentiation 4 count (180 cells/mm³, a blood test that shows how strong your immune system is), it is very important to carefully manage both treatments together and watch for drug interactions and side effects.

One of your main concerns- Rifampicin interacting with Dolutegravir-is valid. Rifampicin can lower the levels of Dolutegravir in the blood, which may reduce its effectiveness. In most cases, doctors do not stop or change the TLD (Tenofovir/Lamivudine/Dolutegravir) regimen. Instead, the usual recommendation is to increase dolutegravir to twice daily while you are on TB treatment, so that HIV remains well controlled.

The nausea (feeling like you want to vomit) and poor appetite you are experiencing are common side effects of the four-drug TB regimen (HRZE- Hisoniazid, Rifampicin, Zpyrazinamide, and Ethambutol). You can manage this by:

Eating small, frequent meals instead of large ones.
Taking medicines with food (if advised by your doctor).
Staying well hydrated.
Using anti-nausea medicines if prescribed.
Regular monitoring of liver function tests is also important, as both TB and HIV medicines can affect the liver.

Having both HIV and TB together can slow immune recovery compared to HIV alone, especially when CD4 counts are low. However, with good adherence to both ART (antiretroviral therapy, the daily medicines that control HIV) and TB treatment, your immune system can still recover gradually over the next few months.

Since your CD4 count is 180 cells/mm³, you are at a higher risk of IRIS (immune reconstitution inflammatory syndrome). This means you may temporarily feel worse or notice worsening TB symptoms after immune recovery begins. If you develop new symptoms such as high fever, worsening cough, swollen lymph nodes, or breathing difficulty, you should inform your doctor immediately.

With close follow-up, good adherence to both treatments, and proper management of side effects, most people with HIV-TB co-infection do well and achieve long-term immune recovery and viral suppression.

I hope this helps.

Please revert in case of further queries.

Thank you.