Review of Pharmacology - 9E (2015)

Review of Pharmacology
Post exposure prophylaxis
(PEP) for HIV is given for 4
weeks
Anti-Retroviral Therapy (ART)
Highly active anti-retroviral therapy (HAART) also known as combination ART (cART) is
recommended with the primary goal of complete suppression of viral replication (viral load
100,000/mm 3 )
• Active hepatitis B or C
• High risk factors for cardiac disease
• Renal impairment due to HIV
• Pregnancy
• Patients without chronic active hepatitis but
CD4 < 350 cells/mm 3 • Risk factors for non-AIDS related
cancers
What to Start
WHO (2010) NACO (2011) US
First Line 2 NRTI+INNRTI 2NRTI + 1NNRTI 2NRTI + 1NNRTI/PI
[Z/T + L/Em + Ef/N] [Z/S + L + Ef/N] [T + Em + Ef × At/R
Preferred to start T + L + Ef Z + L + N T + Em + Ef
2nd Line T + L/Em + At/Lo T+L+At/Lo 3 drugs from at least
2 groups to which the
patient is not resistant
National Aids Control Organization (NACO) 2011Guidelines for Management of Hiv/Aids
Art should be started as given in table above. Zidovudine, lamivudine and nevirapine
should be started as first line. If Hb is < 8 g%, zidovudine should be replaced by stavudine
[S+L+N]. If co-existing TB is present, replace nevirapine with efavirenz because of additive
hepatotoxicity of nevirapine with ATT.
Drugs Drugs Comment
Regimen I Z + L + N Preferred
Regimen I (a) S + L + N If Hb < 8 g%
Regimen II Z + L + E If co-existing TB
Regimen II (a) S + L + E Both TB and Hb < 8 g%
Regimen III T + L + N Intolerant to both Z and S
Regimen III (a) T + L + E Intolerant to both Z and S and Hb < 8g%
Regimen IV Z + L + At Intolerant to both N and E
Regimen V T + L + At Both first line NRTI not tolerated
If both zidovudine and stavudine are not tolerated, tenofovir is recommended. combination
of atazanavir with ritonavir is used if both efavirenz and nevirapine cannot be used.
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post-exposure prophylaxis
It is considered for health care workers and others who get accidental exposure to HIV
infection. Aim is to suppress local viral replication prior to dissemination, so that the infection
is aborted.
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