ARV Drugs & other Therapies Archives - Page 3 of 7

Approach to assessing antiretroviral drug hypersensitivity

Diagnosis Skin prick and intradermal testing with the drug under investigation, followed by a confirmatory oral provocation test, has been the gold standard for identification of drugs associated with immediate hypersensitivity reactions to antibiotics.82,83 For antiretroviral drug hypersensitivity reactions, the majority of cutaneous reactions are delayed and drugs are primarily available as oral preparations and …

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Tables and Figures

Table 1: Most frequent non-immune mediated adverse reactions reported to currently utilized antiretroviral drug Drug Gastrointestinal Neurological Renal (biochemical) Renal (obstructive) Metabolic Musculoskeletal Hepatic Respiratory Cutaneous (non-rash) Nucleoside reverse transcriptase inhibitors (NRTI) Abacavir + – + – ++^ – – – – Lamivudine + + ° – – +^ – + – – Emtricitabine ++ …

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References

Phillips EJ. Classifying ADRs – does dose matter? Br J Clin Pharmacol. 2016; 81:10-2. Drug hypersensitivity. Pichler WJ (ed), Karger, Basel, 2007. Nuesch R, Srasuebkul P, Ananworanich J, et al. Monitoring the toxicity of antiretroviral therapy in resource limited settings: a prospective clinical trial cohort in Thailand. J Antimicrob Chemother. 2006; 58:637-44. Pirmohamed M, Park BK. …

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Drug-drug interactions in patients with HIV infection

Alison Duncan1 and Dianne Carey2 Pharmacy Department, The Alfred Hospital, Melbourne, VIC 3004 The Kirby Institute, UNSW Sydney, NSW 2052 Last reviewed: November 2019 Overview Drug-drug interactions between antiretroviral (ARV) drugs and co-prescribed medication are common and may lead to an increase or decrease in exposure to either drug. These alterations in exposure may result …

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Types of drug-drug interactions

Drug-drug interactions can be either pharmacokinetic or pharmacodynamic in nature. Pharmacokinetic interactions are the primary concern with ARV drugs. Pharmacokinetic interactions occur when one drug alters the absorption, distribution, metabolism or excretion of another drug, possibly increasing or decreasing its plasma concentration. For ARV drugs the interaction types of concern are absorption, metabolism and excretion. …

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Important drug-drug interactions to consider

In general, watch out for the potent enzyme inducers such as rifampicin, rifabutin, phenytoin and carbamazepine Specific interactions by ARV drug class to be aware of and their management, where appropriate, include: INSTIs Dolutegravir with metformin: adjust metformin dose. All INSTIs with cationic chelation (e.g. iron, magnesium, calcium, zinc), including antacids containing these cations: separate …

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Immune reconstitution inflammatory syndrome and other immune reconstitution disorders

Christina C. Chang1, Martyn A. French2 Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne VIC UWA Medical School and School of Biomedical Sciences, The University of Western Australia, Perth WA Last reviewed: July 2019

Introduction

The advent of antiretroviral therapy (ART) revolutionised the care of patients with human immunodeficiency virus (HIV) infection. However, from the late 1980s, when zidovudine monotherapy was introduced, through to the late 1990s, when combination ART became standard of care, clinicians began to recognise that some patients experienced an exacerbation of a previously treated opportunistic infection or …

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Terminology and classification

An IRIS is best described in relation to the type of provoking pathogen e.g. tuberculosis-associated IRIS (TB-IRIS) or cryptococcosis-associated IRIS (C-IRIS) because the immunopathogenesis may differ for different types of pathogen. Further classification is based on the body locality or organ involved, e.g. cryptococcal meningitis IRIS (CM-IRIS), or MAC-IRIS lymphadenitis. The temporal relationship between recognition …

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IRIS definitions and diagnosis

There are no accepted diagnostic tests for an IRIS. Diagnosis of an IRIS is therefore made clinically on the basis of the temporal relationship between starting ART and disease onset, disease manifestations including exclusion of alternative diagnoses, a fall in plasma HIV viral load (indicating that ART is effective) and direct or indirect evidence of …

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