Dosing of raltegravir when given with rifampicin

WHO (1) recommends that, in resource-limited settings, a first-line antiretroviral treatment (ART) regimen should contain two nucleoside reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor (preferably efavirenz in patients on concomitant tuberculosis treatment). Partly because of cost considerations, raltegravir is not included as a first-line option in WHO guidelines and is not widely used in resource-limited settings. In high-income settings, raltegravir is included as an option for first-line regimens (2). Even in resource-limited settings, raltegravir is an attractive option for patients who cannot tolerate efavirenz, and if its price could be reduced it might be used more widely.