Effect of HIV on bedaquiline and delamanid pharmacokinetics in patients with multidrug-resistant TB

<sec><title>BACKGROUND</title>Bedaquiline and delamanid are key drugs in the treatment of multidrug-resistant TB. It is unclear whether HIV affects the pharmacokinetics of bedaquiline and delamanid.</sec><sec><title>METHODS</title>Participants with multidrug-resistant TB were randomised to treatment with bedaquiline, delamanid, or both, plus a standard-of-care treatment. Intensive pharmacokinetic sampling was performed after 8 weeks of therapy. We performed non-compartment analysis to describe bedaquiline and delamanid pharmacokinetics, comparing exposures between HIV-positive and HIV-negative participants using geometric mean ratios (GMRs), and explored covariates associated with bedaquiline and delamanid AUC, using multivariable regression modelling.</sec><sec><title>RESULTS</title>Twenty-six participants were assigned to bedaquiline, 25 received delamanid, and 24 received both drugs. Fifty and 49 participants were treated with bedaquiline and delamanid, respectively. The GMR (90% confidence interval [CI]) of bedaquiline AUC_0-22 and C_max in HIV-positive compared with HIV-negative participants was 0.76 (0.61-0.94) and 0.94 (0.78-1.06), respectively. The GMR (90% CI) of delamanid AUC_0-23 and C_max in HIV-positive compared with HIV-negative participants was 0.93 (0.79-1.09) and 0.79 (0.49-1.27), respectively.</sec><sec><title>CONCLUSION</title>HIV infection was associated with a 24% reduction in bedaquiline AUC_0-22, the significance of which requires further exploration. Delamanid exposure was unaffected by HIV status.</sec>.