Rifabutin is an anti-tuberculosis (TB) medicine in the rifamycin class of drugs. Rifamycins are one of the most important classes of drugs used to treat TB, and within this class, the drug rifampicin is one of the primary drivers of TB-killing activity in the standard six-month, four-drug regimen for treatment of drug-sensitive TB (DS-TB). Compared to other rifamycins such as rifampicin and rifapentine, rifabutin has fewer drug-drug interactions with protease inhibitors, a class of drugs frequently used to treat HIV. For this reason, rifabutin can simplify TB treatment in patients with HIV who are receiving certain protease inhibitors and non-nucleoside reverse transcriptase inhibitors.
India is considered a TB/HIV high-burden country by the World Health Organization. An estimated 2.1 million people in India are living with HIV, over 100,000 people with HIV are diagnosed with TB each year, and TB accounts for 25 percent of all deaths in people with HIV in India. The RNTCP recommends that rifampicin be replaced with rifabutin when an HIV antiretroviral regimen consists of the drugs lopinavir/ritonavir. Despite this recommendation, frequent auditing of TB drug stocks at ART centers by DNP+ suggests that most people with TB/HIV in India cannot obtain rifabutin.
Most recently, on 2 June 2016, DNP+ wrote a letter to V.S. Salhotra, Addl. DDG TB program, about the unavailability of rifabutin at DOTS centers in Uttar Pradesh. A 36 year old woman with HIV on second-line ART who sought rifabutin for her TB treatment at the Baghpat area DOTS clinic was told that the clinic’s stock of rifabutin had never arrived. The clinic told the woman to purchase rifabutin from a private pharmacy, but the prohibitive cost prevented her from doing so. Upon sending the letter, DNP+ received similar reports of rifabutin supply interruptions from colleagues in Bihar, Pune, and Nagaland. On 3 June 2016, Addl. DDG Salhotra responded that the program had released 9632 rifabutin capsules to Uttar Pradesh. However, stock outs of rifabutin are frequently reported to DNP+, and the central government has yet to unveil a nationwide solution to this problem.