Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

Tables

Table 6. Dosing Recommendations for Drugs Used to Treat or Prevent Opportunistic Infections That Require Dosage Adjustment in Patients with Renal Insufficiency

Drug accumulation is the primary concern when renally cleared drugs are administered to patients with reduced renal function. However, clearance is only one of two or more pharmacokinetic parameters that affect a drug’s disposition. All drugs have a volume of distribution, which can be altered. Also, oral drugs must be absorbed from the gastrointestinal tract.

Some patients with HIV or diabetes mellitus can also have reduced absorption of certain drugs. Therefore, while a drug may require a dose reduction in renal failure based on reduced clearance (i.e., increased concentrations), other factors—like an increased volume of distribution and reduced oral absorption—may also affect drug concentrations (i.e., decrease concentrations). Therapeutic drug monitoring (TDM), if available and appropriate, may facilitate any necessary dose adjustments in these complicated patients. TDM allows the clinician to make informed, individualized decisions about dose adjustments that are more precise than standardized dose adjustments based on estimated creatinine clearance. Drug names below marked with asterisk (*) are known to have assays available within the United States and typically in Europe as well.