Table 3

Dose modification of anti-retroviral therapy in adult HIV infected patients with renal failure 45 – 52

Dosage adjustments in adults related to creatinine clearance (degree of renal impairment):
Drug30–60 ml/min (mild)10–30 ml/min (moderate)<10 ml/min (severe)i
a The manufacturers recommend avoidance in “severe” renal impairment. Preliminary evidence suggests no dose change required for any level of renal impairment.48
b Further dose reductions if weight <60 kg.
c Manufacturers recommend a loading dose and first dose reduction at CrCl <50 ml/min, second dose reduction ar CrCl <30 ml/min, third dose reduction at CrCl <15 ml/min
d Further dose reduction to 25 mg once daily at CrCl <5 ml/min
e These dose changes recommended at CrCl of <50 and <25 ml/min respectively
f This dose recommended at CrCl <40 ml/min
g The non-nucleoside reverse transcriptase inhibitors are primarily liver metabolised and plasma levels should not be affected by renal disease.49–51 Of the non-nucleoside reverse transcriptase inhibitors, only efavirenz is recommended by its manufacturers for use in renal disease with “caution” in “severe” renal impairment.45
h Protease inhibitors are liver metabolised and so dose adjustment is not necessary in renal disease.45–47
i Although data are limited, it is suggested that these doses also apply to haemodialysis and peritoneal dialysis and doses should be administered after haemodialysis.52
Nucleoside analogues
AbacaviraNo changeNo changeNo change48
Didanosineb200 mg once daily150 mg once daily100 mg once daily
Lamivudinec150 mg once daily100 mg once daily50 mg once dailyd
Stavudineb20 mg twice daily20 mg once dailye20 mg once daily
ZalcitabineNo change0.75 mg twice dailyf0.75 mg once daily
ZidovudineNo changeNo change300–400 mg once daily
Non-nucleoside RTI49–51
DelavirdinegUnknown, theoretically no dose change required
EfavirenzgNo changeNo changeNo change
NevirapinegUnknown, theoretically no dose change required
Protease inhibitorsh
AmprenavirNo changeNo changeNo change
IndinavirNo changeNo changeNo change
NelfinavirNo changeNo changeNo change
RitonavirNo changeNo changeNo change
SaquinavirNo changeNo changeNo change