1.name five causes of distended uterus. 11.what is the active management of third stage of labor? i.v. ergometrine is given following the birth of anterior shoulder. the placenta is delivered by the controlled cord traction soon after the endometrial polyp delivery of the baby availing first uterine contraction. if the first attempt fails, another attempt is made after 2-3 minutes
Pancap.org2012 Eleventh edition
In collaboration with: Acknowledgements
Edited by Keith Alcorn, Selina Corkery
Al pharmaceutical companies that provided and Greta Hughson product information: Abbott Laboratories, Eleventh edition, 2012 Boehringer Ingelheim, Bristol-Myers Squibb, Due for review in 2013 Gilead Sciences, Janssen, Merck Sharp and Dohme, Roche Products, and ViiV Healthcare.
Thanks to the following for their assistance:Dr Paul Benn, HIV lead, Mortimer Market NAM is grateful to the funders of this Centre, Central & North West London NHS booklet series: Department of Health, NHS Pan-London HIV Prevention Programme and Sharon Byrne, Co-chair, HIV Pharmacy AssociationNeal Marshall, Specialist pharmacist, HIV Contact NAM to find out more about the services, Royal Free Hampstead NHS Trust scientific research and information used to Leonie Swaden, Consultant pharmacist, HIV produce this booklet.
medicine, Royal Free Hampstead NHS TrustWillie TurnbullDr Laura Waters, HIV consultant, Mortimer Market Centre, Central & North West London NHS Foundation Trust This booklet is a starting point for anyone who wants to know about treatments for HIV. It provides basic information about the drugs that fight HIV – known as antiretroviral drugs – and deals briefly with dosing, side-effects, drug interactions and drug resistance. Information contained in this booklet has been reviewed by a panel of medical experts. For ful details of side-effects and drug interactions, see the product information leaflets that are produced by drug manufacturers for each drug.
This information was correct at the time of going to press (March 2012). The booklet includes information on drugs which have been licensed in the UK or European Union and are recommended for prescription by the British HIV Association. The booklet has been written to help you decide what questions to ask your doctor about any course of treatment you might be considering. We don't intend it to replace discussion with your doctor about your treatment.
HIV and anti-HIV drugs
HIV and anti-HIV drugs
It becomes unable to fight infections and
a condition called AIDS (acquired immune
HIV is a virus which attacks the immune deficiency syndrome) fol ows. Antiretroviral
system – the body's defence system against drugs work by interrupting this process. infection and il ness. If you have HIV, you can take drugs to reduce the level of HIV in your The aim of treatment
body. By taking these drugs, you can slow An untreated person with HIV may have down or prevent damage to your immune thousands or even mil ions of HIV particles system. These drugs are not a cure, but they in every mil ilitre of blood (‘copies'). The aim can help you stay wel and lead a longer and of treatment is to reduce the amount of HIV healthier life. Anti-HIV drugs are known as (known as the ‘viral load') to very low levels; this is cal ed an ‘undetectable' viral load. This is generally below 50 copies per millilitre of How antiretroviral drugs work
blood, but there are some ultra-sensitive tests HIV mainly infects cel s in the immune system that can measure below 20 copies/ml. cal ed CD4 cel s. Over many years of HIV infection, the number of CD4 cel s drops gradual y but You can find out more about viral load testing in continual y and the immune system is weakened. the NAM booklet CD4, viral load & other tests.
HIV and anti-HIV drugs
To give you the best chance of reducing reviewed regularly. The most recent guidelines the amount of HIV in your blood to an on HIV treatment were produced in 2012.
undetectable level, your doctor wil usual y recommend that you take a powerful When to start treatment
combination of at least three antiretroviral There is no clear point when anyone with HIV drugs (sometimes known as highly active
should start treatment with anti-HIV drugs. antiretroviral therapy, or HAART). Once your
Your doctor wil discuss a range of issues with viral load has become undetectable, your you, before working with you to decide when immune system should begin to recover, and you should start. This wil include weighing up your ability to fight infections and your general the likely benefits and risks for you of starting health are likely to improve. treatment as opposed to waiting until later.
HIV treatment guidelines
It is recommended in the UK HIV treatment In the UK, standards for HIV treatment and guidelines that you start taking HIV treatment care are set and monitored by the British immediately if you are il because of HIV, or if HIV Association, or BHIVA, the professional you have an AIDS-defining il ness. association for HIV doctors and other healthcare professionals. These standards are HIV and anti-HIV drugs
If you do not have any symptoms, then treatment as soon as you are ready. In some these guidelines recommend that you start situations – for example, if you have another treatment when your CD4 cel count is health condition such as hepatitis – your around 350. CD4 cel s are a type of immune doctor may recommend you start treatment system cel , and doctors use the number of when your CD4 cel count is stil above 350. CD4 cel s you have as a marker of the health Studies to determine the best time to start of your immune system. Clinics use a test HIV treatment are being carried out.
that measures the number of CD4 cel s in a cubic mil imetre of blood. CD4 cel counts in You can find out more about the UK HIV HIV-negative people range from about 500 treatment guidelines in the NAM booklet to 1500. You can find out more about CD4 cell HIV therapy.
counts in the NAM booklet CD4, viral load & other tests.
Your doctor may ask you if you want to participate in a clinical trial. Clinical trials for Your doctor should start discussing HIV people starting HIV treatment may look at the treatment with you when your CD4 cell best time to start HIV treatment, or compare count is approaching 350. Once your CD4 cell different combinations of anti-HIV drugs. You count is around 350, you are advised to start can find out more about taking part in a clinical HIV and anti-HIV drugs
trial in NAM's factsheets The importance of regular check-ups
If you have HIV, you should see a doctor regularly for a check-up. Most people with Starting HIV treatment with a low
HIV attend sexual health clinics or specialist CD4 count
HIV clinics that have doctors and other health Modern HIV treatment is highly effective. professionals trained in HIV care. Even if you Many people who start HIV treatment when do not need to start HIV treatment at this their CD4 count is already low (200 or stage, regular blood tests will tell you about under) wil see it start to climb after starting the health of your immune system and indicate treatment. Long-term HIV therapy can result in when you should think about starting. your CD4 count returning to the normal level for someone of your age. However, if possible, If you are entitled to free NHS care, this care it is better to start treatment before your CD4 and the anti-HIV drugs provided through count drops this low. It can be harder to bring NHS HIV clinics and sexual health clinics your CD4 count back up to a normal level for are free. Your HIV clinic or an HIV support your age if it has been very low at one time.
organisation wil be able to tel you if you are eligible for free NHS care.
HIV and anti-HIV drugs
Monitoring the safety and
Once you are on HIV treatment, you wil have tests effectiveness of HIV treatment
to measure liver and kidney function, and the levels Before you start taking anti-HIV drugs, or if of fat (cholesterol) and sugar in your blood, to you need to switch to a new combination, assess any effects of the drugs on these systems.
you should have a number of blood tests. Your HIV care wil also involve a number of Viral load and CD4 tests will tell you if your other routine tests. These wil monitor your HIV is progressing and about the health of general health, to see if your treatment is your immune system. causing any side-effects.
When you start or change a drug combination, For more information, see the NAM booklets a viral load wil be done within the first month, CD4, viral load & other tests and Adherence & to check that the drugs are working. After this, resistance. testing is general y performed every three to four months, although some doctors may Preparing to start your HIV treatment
perform tests more often to begin with and Taking antiretroviral therapy is a long-term less frequently once you are established on commitment. At present, once you start the drugs, treatment and doing wel . you are likely to be on them for the rest of your life. HIV and anti-HIV drugs
You are more likely to take your HIV treatment chances are that there wil be a combination of correctly if you are involved in the decisions anti-HIV drugs available that wil mean you don't about when to start treatment and about have to change your lifestyle at al , or make only which drugs to start treatment with.
modest alterations to your routine.
Being honest about your lifestyle with yourself Your doctor wil also test to see if your HIV and with your doctor can help ensure that you has any resistance to any of the antiretroviral start on a drug combination that is right for drugs. This is because it is possible to you. It's a good idea not to make unrealistic be infected with a strain of HIV that has demands on yourself, and to think about how developed resistance to some drugs.
taking medication wil fit in with your eating and sleeping patterns, and with your work, Clinics also do a genetic test (called HLA- family and social life. B*5701) to see if you may be more likely to develop an al ergic (hypersensitivity) reaction Discuss your daily routine with your doctor, to the anti-HIV drug abacavir (Ziagen, also in adherence nurse or pharmacist to help establish the combination pills Kivexa and Trizivir). the best times to take your anti-HIV drugs and For more information, see the NAM booklet to identify any concerns before you begin. The HIV and anti-HIV drugs
Taking your HIV treatment
If you need to change HIV treatment because It is very important not to miss doses of your your viral load becomes detectable again (see anti-HIV drugs and to take them exactly as The aim of treatment on page 1), then your prescribed. If you miss doses, or you do not choice of new drugs should be guided by take the drugs as prescribed, the HIV in your having another resistance test at this stage to body is more likely to develop resistance to see which drugs will work for you.
them, and sometimes to other drugs in the same class. This can mean the drugs stop Even if you have resistance to several drugs, working. Developing a routine wil help with the range of anti-HIV drugs available now this, as can using other reminders such as the means there will still be options for you. An alarm on your mobile phone or a pil box with undetectable viral load is a realistic objective for nearly everyone, including people who have taken a lot of different treatments in the To help make sure that you take the right past and have drug-resistant virus. combination of anti-HIV drugs, you should have a test to see if you already have any drug If you are having difficulty sticking to your resistance before you start treatment. drug routine, discuss alternative combinations that may be easier to take with your doctor or HIV and anti-HIV drugs
pharmacist. There are many tips and aids which your doctor, especially if they are interfering with may help you take your drugs as required. For the quality of your life. There may be other drugs more information, speak to your healthcare team, you can try that will suit you better.
Certain side-effects, such as rash and fever, should Further information can also be found in NAM's be reported to your doctor promptly (see entries booklet Adherence & resistance. on individual drugs for information on potential y dangerous side-effects requiring quick action).
Like all medications, anti-HIV drugs can cause
In this booklet, we general y divide side-effects side-effects. Quite often, these happen during the first few weeks of treatment. Your doctor can prescribe a number of drugs to help you Common – a side-effect which occurs in at least cope with this initial period. one in a hundred patients who take this drug.
Rare – a side-effect which occurs in fewer than Side-effects most commonly reported include one in a hundred patients who take this drug. headache, nausea, diarrhoea, and tiredness. You We have included rare side-effects if they are don't have to ‘grin and bear' side-effects – tell HIV and anti-HIV drugs
You wil be monitored at your regular HIV clinic another doctor, over-the-counter drugs, herbal visits to see if any side-effects might be causing and alternative treatments, and recreational drugs. you to develop longer-term health problems.
Some drug combinations are contraindicated You can find out more about side-effects – which means you definitely should not take and how to deal with them in NAM's booklet them together. Reasons for this include serious side-effects, or interactions which make one or both drugs ineffective or toxic. Drug interactions
Taking two or more different drugs together
Other interactions are less dangerous, but still may result in an alteration in the effectiveness need to be taken seriously. Levels of one or or in the side-effects of one or more of the both drugs in your blood may be affected and drugs. Some drugs should not be taken in you may need to change the doses you take. combination with certain antiretrovirals. Your HIV doctor and pharmacist wil check for It is important that your doctor and pharmacist possible interactions before they prescribe a know about al other medicines and drugs that new drug for you.
you are taking – this includes those prescribed by HIV and anti-HIV drugs
If any other healthcare professional prescribes indigestion and statins (drugs that are used or recommends a medicine for you, it's to control cholesterol, or lipid levels). These important that they know about the drugs you treatments can either be prescribed or bought are taking for your HIV. For example, it's known over the counter at high-street chemists. that treatments for erectile dysfunction (such as Viagra) can interact with types of anti-HIV If you are thinking of using any other drugs, drugs that belong to the drug classes protease you should tel your HIV doctor or pharmacist inhibitors (PIs) and non-nucleoside reverse so they can check for possible interactions and transcriptase inhibitors (NNRTIs). Interactions recommend the most suitable treatment. Or, with protease inhibitors can increase blood when you are buying them, you may wish to levels of Viagra and similar drugs, increasing tel the pharmacist about the anti-HIV drugs the risk of side-effects. you are taking. High-street chemists often have a private area for consultations, or you You also need to tel your HIV doctor about any could write the name of the drugs down and drugs you buy over the counter (at a chemist, hand them to him or her. If you do need to for example) or from the internet. Some anti- mention the name of your anti-HIV drugs, HIV drugs can interact with antihistamines, it's very unlikely that anyone around you will asthma drugs (steroids), treatments for recognise what they are used to treat. HIV and anti-HIV drugs
Less is known about interactions with Test-tube studies have indicated that African recreational drugs. But there are potential potato and Sutherlandia may reduce levels interactions between some recreational of PIs, NNRTIs and maraviroc (Celsentri) in drugs (for example, ketamine, ecstacy and methamphetamine [crystal meth]) and some NNRTIs and PIs. If you use recreational drugs, it Interactions can also happen with medicines is sensible to discuss this with your doctor, HIV that are not taken by mouth. For example, pharmacist or other healthcare provider. ritonavir can interact with inhalers and nasal sprays containing fluticasone and salmeterol Anti-HIV drugs can also interact with herbal (e.g. Flixotide, Flixonase, Seretide and and alternative treatments. In many cases, the Serevent), causing serious side-effects. interactions are theoretical, or seen in test-tube studies, and more information is needed You can take painkil ers, such as paracetamol about the likelihood of a real-life effect.
or ibuprofen (e.g. Nurofen), when on anti-HIV drugs, unless there are other medical reasons St John's wort, a herbal remedy used to treat why you shouldn't take this sort of drug.
anxiety and depression, lowers blood levels of NNRTIs and PIs. HIV and anti-HIV drugs
Make sure you tel your clinic doctor and reduces the risk of passing on HIV to the baby, HIV pharmacist about all the medicines
so the benefits outweigh any risks. you are taking. This includes prescribed medicines, medicines you buy from a General y, anti-HIV drugs are not used during chemist, herbal or traditional medicines, the first three months of pregnancy unless you and recreational drugs. Also check before are already on treatment. Pregnant women are taking anything new (whether you buy it recommended to start HIV treatment between yourself or have it prescribed by a doctor 14 and 24 weeks of pregnancy (depending on your health and viral load), unless you need to take it earlier for your own health. You may also be recommended to start earlier if you have a HIV treatment and pregnancy
high viral load.
Antiretroviral drugs are used during pregnancy as an effective means of preventing the As a woman's health improves, her fertility transmission of HIV from a mother to her may also increase. If you are thinking about baby. Increasingly, evidence suggests that HIV becoming pregnant, it's recommended you treatment during pregnancy is not harmful. discuss this with your healthcare team before Taking HIV treatment during pregnancy greatly you try to conceive. You should tel your HIV HIV and anti-HIV drugs
doctor or another member of your healthcare For more information, see the NAM booklet team immediately if you become pregnant. HIV & women. You can discuss your treatment options with them and they wil often help to arrange your There is no evidence that a baby conceived antenatal care and work with other staff, when the father is on treatment wil be such as an obstetrician, to ensure you get the affected by the anti-HIV drugs. appropriate care.
How anti-HIV drugs are dispensed
Some forms of hormonal contraception, You will get a prescription for your HIV including patches and implants, are less treatment, when you attend your regular effective in women on many of the anti-HIV HIV clinic appointment, which you take drugs, because of drug interactions. Most to either the specialist HIV pharmacy (in other forms of contraception are unaffected larger clinics) or to the hospital's outpatient by having HIV or being on HIV treatment and pharmacy. A high-street chemist will not some new drugs do not affect contraception. usually dispense anti-HIV drugs, unless You can find out more about contraception your clinic has an agreement with a options from your healthcare team.
HIV and anti-HIV drugs
You should be given supplies to last until your to you. Pharmacists can help you with next clinic appointment. Once you are stable managing your medication use, including on HIV treatment, with an undetectable viral adherence, side-effects, drug interactions, load, you may be able to arrange with your food and drink requirements, storage, clinic to have your HIV treatment delivered pill swallowing, and advice information on ‘home' delivery, sometimes also cal ed local delivery). You wil stil need to Names of anti-HIV drugs
attend regular HIV clinic appointments to have Pharmaceutical drugs are given several names: your health monitored. Always make sure you have enough medication to last until your next First, a research name based on its chemical clinic appointment. If you think you might run make-up or manufacturer, e.g. DMP266. out before this, contact your clinic as soon as possible to arrange a further supply.
Second, a generic name which is the chemical name of the medicine e.g. efavirenz. The pharmacist will ask you if you are al ergic to any medicines and explain how Third, a brand name which belongs to a particular to take the drugs that have been prescribed company. A brand name starts with a capital letter HIV and anti-HIV drugs
and is generally written in italics, e.g. Sustiva. Non-nucleoside reverse transcriptase inhibitors (NNRTIs), which also target reverse This booklet lists the most common names a transcriptase, but in a different way to NRTIs drug has at the start of a drug entry. The most common name for each drug is used in the text. Protease inhibitors (PIs), which target an HIV Types of antiretroviral drugs
protein cal ed protease. There are six main types (‘classes') of antiretroviral drugs: Entry inhibitors, which stop HIV from entering human cel s. There are two types: Nucleoside reverse transcriptase inhibitors Fusion inhibitors and CCR5 inhibitors. CCR5 (NRTIs) and nucleotide reverse transcriptase inhibitors won't work in everyone and are inhibitors (NtRTIs), which target an HIV protein not often used for first-line treatment. cal ed reverse transcriptase, You would have a test to see if this type of treatment would be effective before This class of drugs forms the ‘backbone' of a first- starting on it.
line HIV treatment combination and is usual y taken in a pill that combines a number of drugs.
Integrase inhibitors, which target a protein in Triple-drug combination pills
HIV cal ed integrase, and stop the virus from Triple-drug
integrating into the DNA of human cel s. Each class of drug attacks HIV in a different There are now fixed-dose pil s that combine way. General y drugs from two (or sometimes three anti-HIV drugs, from more than one class three) classes are combined to ensure a of drug. These allow many people to take their powerful attack on HIV. HIV treatment in one pill, once a day.
The drugs listed in this booklet are those There are other combination pills combining two licensed for use in the UK or the European drugs from a single class. These can reduce the Union, and which have been recommended for number of pills in someone's treatment regimen, use in BHIVA's 2012 HIV treatment guidelines. but they still need to be taken with at least one There may be occasions where other anti- other drug as well. These combinations are listed HIV drugs, not covered here, are prescribed under their drug class later in the booklet.
because of very unusual circumstances. You can find out about these drugs on NAM's Atripla provides triple-drug combination treatment in one pil , taken once a day. It Triple-drug combination pills
combines 200mg of FTC (emtricitabine), You can do this if you find it helpful, but avoid 245mg of tenofovir and 600mg of efavirenz. taking it with a high-fat meal; this may increase The dose is one pink tablet once a day. absorption of the drug, potentially increasing side-effects. If Atripla causes confusion or Side-effects: Most commonly, these include dizziness (because of the efavirenz, which often sleep disturbances, tiredness, abnormal happens during the first few weeks of taking dreams, impaired concentration, dizziness, it), some people find it helpful to take it before rash, nausea, vomiting, diarrhoea, headache, anxiety, depression, raised creatine kinase levels, skin darkening, low blood phosphate Resistance: Resistance to efavirenz usual y levels, weakness, rash, stomach pains, causes resistance to another NNRTI cal ed tiredness, bloating, flatulence. See the entries nevirapine, and possibly to the NNRTI on FTC, tenofovir and efavirenz for more detail.
rilpivirine. However, another NNRTI, etravirine, is still likely to be effective.
Tips on taking it: Take once a day. In the UK and Europe, it is recommended that Atripla should Key drug interactions: See the entries on FTC, be taken on an empty stomach. Some people tenofovir and efavirenz.
find taking it with food reduces side-effects. Triple-drug combination pills
Rare side-effects: Changes in heart rhythm Eviplera provides triple-drug combination (known as QT prolongation).
treatment in one pil , taken once a day. It combines 200mg FTC (emtricitabine), Key drug interactions: Medicines that 25mg rilpivirine and 245mg tenofovir, in one affect your stomach acidity can block the way Eviplera is absorbed. Don't take proton pump inhibitors (PPIs) such as omeprazole Tips on taking it: One tablet, once a day. with Eviplera. Indigestion remedies cal ed Always take with a meal.
H2-blockers should be taken at least 12 hours before or at least four hours after taking Common side-effects: Nausea, vomiting, Eviplera. If taking other indigestion remedies diarrhoea, dizziness, insomnia, headache, or calcium supplements, they should be taken weakness, rash, stomach pains, fatigue, bloating, at least two hours before or at least four hours flatulence, changes in kidney function, raised after taking Eviplera as they can prevent it creatine kinase levels, low blood phosphate being absorbed properly. levels, skin darkening. Eviplera can cause mood changes and depression. See the entries on FTC, See the entries on FTC, rilpivirine and tenofovir rilpivirine and tenofovir for more detail.
for more information. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
appetite, fever, abdominal pain, hair loss, reverse transcriptase
insomnia, rash, runny nose, joint pain. See the entries on AZT and 3TC for more detail. Tips on taking it: One tablet twice a day with or Most people now take these drugs in a fixed- without food.
dose pil that combines a number of drugs. These combination pil s are listed first and there are Key drug interactions: See the entries on AZT also separate entries on the individual drugs.
This is a combination of AZT (zidovudine) and This drug combines 3TC (lamivudine) and 3TC (lamivudine). The dosage is one white abacavir. The dosage of Kivexa is one orange tablet (150mg 3TC and 300mg AZT) twice a day. tablet (600mg abacavir and 300mg 3TC) once a day. Side-effects: Most commonly, nausea, vomiting, diarrhoea, tiredness, headache, Side-effects: Abacavir can cause a serious dizziness, weakness, muscle pain, loss of hypersensitivity reaction. This is associated Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
with the presence of a particular gene. Before least TWO of the following groups: starting treatment with Kivexa (or any treatment that contains abacavir) you should have an tness of breath, sore throat or cough HLA-B*5701 test to see if you have this gene. If ausea or vomiting, or diarrhoea or the test is positive you must not take Kivexa.
If the test is negative, it is highly unlikely that evere tiredness or achiness or general y an al ergic reaction wil occur, but contact your feeling ill.
HIV clinic immediately (or A&E if out of hours) if you begin to feel unwel after starting the drug. Other side-effects include nausea, vomiting, diarrhoea, headache, abdominal pain, hair In the box with the drug there is an ‘alert loss, fever, insomnia, rash, tiredness, loss of card', which you should carry with you for appetite, runny nose and joint pain. the first six weeks of taking Kivexa. The particular side-effects you should look out See the entries on 3TC and abacavir for for during this time are: more detail.
y skin rash OR
Tips on taking it: Take one tablet, once a day, z f you get one or more symptoms from at with or without food.
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
Key drug interactions: See the entries for 3TC Side-effects: Abacavir can cause a serious and abacavir.
hypersensitivity reaction. This is associated with the presence of a particular gene. Before starting treatment with Trizivir (or any This drug combines 3TC (lamivudine), abacavir treatment that contains abacavir) you should and AZT (zidovudine). The dose is one green have an HLA-B*5701 test to see if you have tablet (300mg AZT, 150mg 3TC and 300mg this gene. If the test is positive you must not
abacavir) taken twice a day. take Trizivir. If the test is negative, it is highly unlikely that an al ergic reaction wil occur, but Treatment with Trizivir is not general y contact your HIV clinic immediately (or A&E if recommended. By itself, its anti-HIV effect out of hours) if you begin to feel unwel after is often not strong enough to suppress viral starting the drug. load to undetectable levels. Furthermore, as it contains AZT, which has been shown to cause In the box with the drug there is an ‘alert card', lipoatrophy, it should not be used if other which you should carry with you for the first treatment options are available.
six weeks of taking Trizivir. The particular side-effects you should look out for during this time are: Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
Tips on taking it: Take one tablet twice a day, z f you get one or more symptoms from at with or without food.
least TWO of the following groups: Key drug interactions: See the entries for 3TC, tness of breath, sore throat or cough abacavir and AZT.
ausea or vomiting, or diarrhoea or evere tiredness or achiness or general y FTC and tenofovir are combined in this pil . feeling ill.
The dose is one blue tablet (200mg FTC and 245mg tenofovir) once a day. Other side-effects include nausea, vomiting, diarrhoea, headache, abdominal pain, hair Side-effects: Nausea, vomiting, diarrhoea, loss, fever, insomnia, rash, tiredness, runny dizziness, headache, rash, weakness, stomach nose, joint pain, weakness, muscle pain and pains, fatigue, bloating, flatulence, raised loss of appetite. creatine kinase levels, low blood phosphate levels and skin darkening. See the entries for See the entries on 3TC, abacavir and AZT for FTC and tenofovir for more detail.
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
Tips on taking it: Take once a day, preferably Children: Approved for use in children. Liquid with food, although you can take Truvada on suspension available. an empty stomach. Tips on taking it: Take with or without food. Key drug interactions: See the entries for FTC and tenofovir.
Common side-effects: Nausea, vomiting, diarrhoea, headache, abdominal pain, hair loss, fever, insomnia, rash, tiredness and joint pain.
Names: 3TC, lamivudine, Epivir Rare side-effects: Lactic acidosis, liver Approved dosage: 300mg daily, as one white 150mg tablet twice a day, or two white 150mg tablets once a day, or one larger, grey 300mg Key drug interactions: 3TC should not be tablet once a day. Also available in a combined used with the anti-HIV drug FTC. 3TC should form with AZT called Combivir, in a combined not be taken with high doses of the antibiotic form with AZT and abacavir called Trizivir, and in a combined form with abacavir called Kivexa. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
Rare side-effects: Hypersensitivity reaction, Names: Abacavir, Ziagen lactic acidosis. Some, but not al , research has linked abacavir with an increased risk of Approved dosage: 600mg daily, either as heart attack. For this reason, abacavir is not one 300mg yel ow tablet twice daily or two recommended if you have other risk factors 300mg tablets once a day. Abacavir and 3TC for heart disease. Your doctor wil discuss are available in a combined formulation called this with you.
Kivexa. Abacavir is also available in a combined form with AZT and 3TC called Trizivir. Important warning: Abacavir can cause a serious hypersensitivity reaction. This is Children: Liquid formulation available. associated with the presence of a particular gene. Before starting treatment with abacavir Tips on taking it: Take with or without food. (or any treatment that contains abacavir) you should have an HLA-B*5701 test to see if you Common side-effects: Nausea, vomiting, have this gene. If the test is positive you must
diarrhoea, fever, headache, abdominal pain, not take abacavir. If the test is negative, it is
tiredness and loss of appetite.
highly unlikely that an allergic reaction will occur, but contact your HIV clinic immediately Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
(or A&E if out of hours) if you begin to feel You should never retry abacavir, or take Trizivir unwel after starting the drug. or Kivexa, if you have had an al ergic reaction to abacavir previously. In the box with the drug there is an ‘alert card', which you should carry with you for the first Key drug interactions: Care should be taken six weeks of taking abacavir. The particular when abacavir is taken with ribavirin, used side-effects you should look out for during to treat hepatitis C. Phenytoin, used to treat epilepsy, may also interact with abacavir.
y skin rash OR
z f you get one or more symptoms from at Names: AZT, zidovudine least TWO of the following groups: Approved dosage: AZT is available as a generic tness of breath, sore throat or cough drug, so its appearance wil depend on which ausea or vomiting, or diarrhoea or type your clinic buys.
evere tiredness or achiness or general y The approved dose is one 250mg capsule feeling ill.
taken twice a day. A 100mg capsule is Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
available for dose variations. Also available in a Key drug interactions: Do not take with the combined tablet with 3TC called Combivir and anti-HIV drug tipranavir. Close monitoring or in a combined tablet with 3TC and abacavir, dose adjustment needed if taking with the antibiotic clarithromycin or phenytoin, a drug used to treat epilepsy. Several other types Children: Approved for use in children. Liquid of drugs, when taken with AZT, can cause an formulation available. increase in side-effects, so it is important to talk to your doctor about any other drugs you Tips on taking it: Can be taken with or without are taking. These include, but are not limited food, but taking with food reduces nausea. to, methadone and drugs to treat infections, cancer and malaria.
Common side-effects: Nausea, vomiting, fatigue, headache, dizziness, weakness, muscle pain, loss of appetite, fever.
Names: FTC, emtricitabine, Emtriva Rare side-effects: Blood disorders, Approved dosage: One blue and white 200mg lipoatrophy, lactic acidosis. capsule once a day. FTC is also available in a combination tablet with tenofovir cal ed Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
Truvada, in a combination tablet with the drug, potential y increasing side-effects. tenofovir and efavirenz called Atripla, and Eviplera should always be taken with food.
in a combination tablet with rilpivirine and tenofovir called Eviplera. Common side-effects: Nausea, diarrhoea, headache, raised creatine kinase levels, skin Note: People who have kidney abnormalities may be advised by their doctor to take a lower dose. Rare side-effects: Lactic acidosis, liver damage. Children: Approved for use by children aged four months and over. Key drug interactions: FTC should not be used with the anti-HIV drug 3TC (lamivudine).
Tips on taking it: Can be taken with or without food. In the UK and Europe, it is recommended that Atripla should be taken on an empty Names: Tenofovir, Viread stomach. Some people find taking it with food reduces side-effects, but avoid taking it with a Approved dosage: One blue 245mg tablet high-fat meal; this may increase absorption of daily. Dose may be adjusted if kidney function Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)
impaired. Also available in a combination tablet Common side-effects: Nausea, vomiting, with FTC called Truvada, in a combination diarrhoea, flatulence, dizziness, low blood tablet with FTC and efavirenz called Atripla, phosphate levels, weakness, rash, headache, and in a combination tablet with rilpivirine and stomach pains, fatigue and bloating.
tenofovir called Eviplera. Rare side-effects: Kidney problems, bone Tips on taking it: Take with food, to increase absorption. However, recommendations in the US say the drug can be taken with or without Key drug interactions: Taking tenofovir and food. In the UK and Europe, it is recommended atazanavir together decreases the concentration that Atripla should be taken on an empty of atazanavir, so it should only be used if boosted stomach. Some people find taking it with food with ritonavir. Protease inhibitors also increase reduces side-effects, but avoid taking it with a concentration of tenofovir, so if taken together high-fat meal; this may increase absorption of your healthcare team should monitor you the drug, potential y increasing side-effects. careful y for side-effects. Eviplera should always be taken with food.
Do not take tenofovir at the same time as the anti-hepatitis drugs adefovir dipivoxil (Hepsera).
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
It's important your doctor knows about any Non-nucleoside reverse
other drugs you are taking in case they increase transcriptase inhibitors
your risk of kidney problems. This includes creatine supplements used to increase exercise performance, as they can interfere with the results of kidney function blood tests. Make sure you tell your doctor if you are taking creatine, and Names: Efavirenz, Sustiva don't take it for two days before any blood tests.
Approved dosage: One dark-yel ow 600mg tablet once a day or three dark-yel ow 200mg capsules once a day. Efavirenz is also available in a combination tablet with FTC and tenofovir (Atripla). Children: Approved for use in children aged three years and above, who weigh more than 13kg. Oral solution available (but note that the Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
dose of the solution is different from the dose feeling ‘out of sorts', confusion, impaired of the tablets or capsules). concentration, sleep disturbance, abnormal dreams, anxiety and depression. In most Tips on taking it: Recommended to take on cases these side-effects go away by an empty stomach. Some people find taking themselves and it isn't necessary to stop it with food reduces side-effects, but avoid taking efavirenz. However, some people taking it with a high-fat meal; this may increase find them intolerable and need to change absorption of the drug, potentially increasing treatment as a result. If you have a history of side-effects. If efavirenz causes confusion or mental health problems, efavirenz may not dizziness, taking before going to bed can help. be a good choice for you. Talk to your doctor about other treatment options. Common side-effects: Rash, dizziness, headache, diarrhoea, nausea, vomiting and Rare side-effects: Severe rash, psychosis, Efavirenz can cause mood and sleep problems. Resistance to efavirenz: Is likely to cause These are most commonly experienced during resistance to nevirapine and possibly to the first four weeks of treatment and include Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Key drug interactions: Some drugs can clarithromycin, rifabutin and rifampicin), anti- interact with efavirenz and cause dangerous fungal treatments, anticonvulsants, statins, side-effects. Do not take efavirenz with the methadone, sertraline, calcium channel anti-hepatitis drug boceprevir; ergot blockers, immunosuppressants and warfarin.
alkaloids (used to treat migraine and cluster headaches and to control labour); midazolam Efavirenz may reduce the effectiveness of (used to help you sleep); pimozide (used to some hormonal contraceptives (such as treat certain mental health conditions); or the ‘pill', patches or an implant). If you are using this type of contraceptive to prevent pregnancy you should use an additional or Some drugs can interact with efavirenz and different type of contraception.
change blood levels of one or both drugs, so dose adjustments may be needed. This is the case for the anti-HIV drugs darunavir, lopinavir/ Names: Etravirine, Intelence.
ritonavir (Kaletra), ritonavir, ritonavir-boosted atazanavir, fosamprenavir and maraviroc. Approved dose: One white 200mg tablet or This is also the case for some drugs used to two white 100mg tablets taken twice a day. treat bacterial infections such as TB (including Your doctor may recommend taking 400mg Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
etravirine once a day. However, do not change or joint aches, blisters, oral lesions, eye to this dosage without consulting your doctor. inflammation, facial swel ing and/or signs and symptoms of liver problems (e.g., yel owing Tips on taking it: Take with food. If you find of your skin or whites of your eyes, dark or it difficult to take the tablet whole, you can tea-coloured urine, pale-coloured stools/ disperse it in a glass of water. Stir it wel and bowel movements, nausea, vomiting, loss of drink it straight away. Add some more water appetite, or pain, aching or sensitivity on your and drink that too, to make sure you have right side below your ribs). If you develop these taken the entire dose.
symptoms whilst taking this drug you should contact your HIV clinic immediately or A&E if Common side-effects: Rash, peripheral out of hours.
Resistance: Etravirine can work in people Rare side-effects: Severe rash, including whose HIV has resistance to other NNRTIs.
Stevens Johnson syndrome. You should watch out for the fol owing symptoms accompanying Key drug interactions: Do not take with any rash if you are starting etravirine: fever, the anti-HIV drugs fosamprenavir/ritonavir, general y feeling il , extreme tiredness, muscle atazanavir/ritonavir, protease inhibitors taken Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
without ritonavir or other NNRTIs. It is not antifungal treatments, immunosuppressants, recommended to take etravirine with some drugs used to treat erectile dysfunction, drugs used to treat epilepsy, rifampicin (an clopidogrel, dexamethasone, diazepam antibiotic used to treat infections, including and warfarin.
TB), or St John's wort. Etravirine may reduce the effectiveness of When taken with the anti-HIV drug maraviroc hormonal contraceptives (such as the ‘pil ', and a protease inhibitor, a dose adjustment of patches or an implant). If you are using this maraviroc may be needed.
type of contraceptive to prevent pregnancy you should use an additional or different type Some drugs can interact with etravirine of contraception.
and change blood levels of one or both drugs, so dose adjustments may be needed. It's important your doctor knows about any Names: Nevirapine, Viramune, Viramune other drugs you are taking, including drugs used to treat bacterial infections, including TB (clarithromycin, rifabutin), statins, drugs Approved dosage: Men should not start used to treat certain heart conditions, treatment with nevirapine if their CD4 cell Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
count is above 400 and women should not begin until the rash has gone away. Always tell start treatment with nevirapine if their CD4 cell your doctor about any rash you develop while count is above 250, as this increases the risk of taking nevirapine. If a rash persists for more potential y dangerous side-effects. than one month, or becomes more severe, an alternative drug should be used.
One white 200mg tablet once a day for the first two weeks and then one 200mg tablet Children: Syrup available. twice a day thereafter.
Tips on taking it: Take with or without food. Alternatively, one 400mg yel ow tablet of Viramune prolonged-release must be swallowed once-daily prolonged-release formulation whole and not crushed, chewed or divided.
(Viramune prolonged-release). People starting HIV treatment wil take a 14-day Common side-effects: Al ergic reaction, lead-in dose of 200mg of immediate-release headache, rash (usual y in the first six weeks of nevirapine in order to reduce the risk of rash, treatment), fatigue, stomach pain, diarrhoea, a common side-effect during the first few nausea and liver toxicity (usual y in the first six weeks of nevirapine treatment. Treatment weeks of treatment). During the first 18 weeks with Viramune prolonged-release should not of treatment with nevirapine, the health of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
your liver wil be intensively monitored; you Resistance to nevirapine: Is likely to cause wil be advised to have liver function tests resistance to efavirenz and possibly to every one to two weeks for the first six weeks. Rare side-effects: Severe rash (Stevens Key drug interactions: Do not take St John's Johnson syndrome). Symptoms include: wort with nevirapine. fever, general y feeling il , extreme tiredness, muscle or joint aches, blisters, oral lesions, Some drugs interact with nevirapine and eye inflammation, facial swel ing, signs and change blood levels of the drugs, which may symptoms of liver problems (e.g., yel owing stop them working or cause side-effects. of your skin or whites of your eyes, dark or These include the anti-HIV drugs atazanavir, tea-coloured urine, pale-coloured stools/ lopinavir/ritonavir (Kaletra), fosamprenavir bowel movements, nausea, vomiting, loss of appetite, or pain, aching or sensitivity on your right side below your ribs). If you develop It's also particularly important your doctor these symptoms whilst taking this drug, you knows if you are taking any of the fol owing should contact your HIV clinic immediately (or drugs with nevirapine, so that the effects can A&E if out of hours).
be monitored: antibiotics used to treat certain Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
infections, such as TB (including rifampicin, Tips on taking it: Always take with a meal.
rifabutin and clarithromycin), anti-fungal treatments, methadone and warfarin.
Common side-effects: Insomnia, headache, rash. May cause depression and mood changes.
Nevirapine may reduce the effectiveness of hormonal contraceptives (such as the ‘pil ', Rare side-effects: At doses above 25mg, patches or an implant). If you are using this changes in heart rhythm (known as QT type of contraceptive to prevent pregnancy you should use an additional or different type of contraception.
Key drug interactions: It's not recommended that rilpivirine be used in combination with Names: rilpivirine, Edurant Do not take rilpivirine with the anticonvulsants Approved dosage: One white 25mg tablet taken carbamazepine, oxcarbazepine, phenobarbital once a day. Also available in a combination tablet or phenytoin or with St John's wort. Rilpivirine with FTC and tenofovir (Eviplera).
should not be taken at the same time as the antibiotics rifampicin and rifabutin (often used to treat TB). Some other antibiotics can increase blood levels of rilpivirine. Most protease inhibitors are prescribed with Medicines that affect stomach acidity can another drug (also a protease inhibitor) cal ed block the way rilpivirine is absorbed. Don't ritonavir. Ritonavir is used to boost the effects of take proton pump inhibitors (PPIs), such as the other protease inhibitor in your body. Without omeprazole. Indigestion remedies called H2- ritonavir, your body would metabolise (break blockers (such as ranitidine, Zantac) should be down) the protease inhibitor too quickly and it taken at least 12 hours before or at least four would not work effectively against the virus. hours after taking rilpivirine. If taking other indigestion remedies or calcium supplements, Drug interactions: Protease inhibitors, they should be taken at least two hours before including ritonavir, have multiple drug or at least four hours after taking rilpivirine as interactions. Most of these are caused by the they can prevent it being absorbed properly. boosting effect of ritonavir, which increases the levels of many drugs, including other It may be necessary to increase methadone doses when taken at the same time as rilpivirine.
Do not take any protease inhibitors with the (Viagra), tadalafil (Cialis) or vardenafil following medication: (Levitra) used at ful dose. Get advice from your HIV doctor or pharmacist before taking z rugs for certain heart conditions, such any drugs for erectile dysfunction as amiodarone, astemizole, flecainide, z rgot derivatives (used to treat cluster lercanidipine, quinidine and dabigatran headaches and migraines and to manage osin (used to treat urinary problems) z he anti-TB drug rifampicin z he lipid-lowering drug simvastatin. Other z t John's wort, the herbal antidepressant. statins such as rosuvastatin and atorvastatin can be used, but at lower doses Some drugs can interact with protease z he anticoagulant (a drug that prevents inhibitors and change blood levels of one blood clotting) rivaroxaban or both drugs, so dose adjustments may be z idazolam, a benzodiazepine used to help needed. This is the case for: you sleep, if taken oral y. Midazolam can be used at reduced dose when injected as a channel blockers (for example, sedative for certain procedures diltiazem and verapamil) z rectile dysfunction drugs, such as sildenafil heart drug digoxin z he anticoagulant warfarin (with the z njectable steroids such as triamcinolone exception of atazanavir) (Kenalog) z he asthma and al ergy drugs fluticasone, chemotherapy drugs.
salmeterol and budesonide (including inhalers or nasal sprays) Methadone levels may be reduced by protease z reatments for acid reflux and ulcers cal ed inhibitors, and require an increase in dose to proton pump inhibitors and H2 receptor achieve the same effect.
Protease inhibitors may reduce the z ome anti-fungal treatments (although effectiveness of some hormonal contraceptives (such as the ‘pil ', patches z nticonvulsants (drugs used to treat or an implant). If you are using this type of epilepsy; for example, phenytoin, contraceptive to prevent pregnancy you may carbamazepine). Some anticonvulsants need to use an additional or different type of should never be used with some PIs (see individual entries) z he anti-TB drugs rifabutin and rifapentine z mmunosuppressants Atazanavir
Rare side-effects: Kidney stones, abnormal Names: Atazanavir, Reyataz liver function, changes in heart rhythm. Approved dosage: One red and blue 300mg Key drug interactions: See the start of this capsule plus one white 100mg ritonavir tablet section on protease inhibitors for more taken together once a day. If the combination information on possible interactions.
also contains efavirenz the dose is 400mg (two turquoise 200mg capsules) plus one 100mg Drugs that affect the acidity of your stomach ritonavir tablet taken together once a day. and gastrointestinal tract can stop atazanavir being absorbed, meaning it may not be Tips on taking it: Take with food to improve effective at suppressing HIV: pump inhibitors (indigestion Common side-effects: Nausea, diarrhoea, rash, remedies that reduce gastric acid, such as stomach ache, headache, insomnia, vomiting, lansoprazole or omeprazole) should not be heartburn, hyperbilirubinaemia (raised taken with atazanavir, unless they have been bilirubin levels, sometimes leading to jaundice), prescribed by your HIV doctor and the dose lipodystrophy, liver toxicity, diabetes.
of atazanavir is increased.
-receptor antagonists (treatments for Atazanavir should not be taken with the anti- ulcers, such as ranitidine [Zantac]) should HIV drug nevirapine or the chemotherapy drug be taken only once a day, 4 to 12 hours after atazanavir. If atazanavir is taken with tenofovir, you should never take The anti-HIV drugs efavirenz and nevirapine reduce the levels of atazanavir in the body and dose adjustments of atazanavir are estion remedies or calcium supplements should be taken at least two hours before or one hour after atazanavir.
Names: Darunavir, Prezista z Buffered' medicines (drugs that have been prepared so they are released slowly into Approved dosage: 800mg (two orange the body) should be taken at least two hours 400mg tablets) plus one 100mg white before or one hour after atazanavir.
ritonavir tablet taken together once a day. For more resistant HIV, your doctor may prescribe Talk to your HIV doctor or pharmacist before one 600mg tablet plus one 100mg ritonavir taking any of these drugs with atazanavir. tablet taken together twice a day. Tips on taking it: Must be taken with food to Do not take darunavir with the anti-HIV drug improve absorption. lopinavir/ritonavir (Kaletra). The lipid-lowering drug pravastatin should be taken with caution Common side-effects: Diarrhoea, nausea, with darunavir.
rash, stomach pain, vomiting, headache, fever, lipodystrophy, liver toxicity, diabetes.
Names: Fosamprenavir, Telzir Rare side-effects: Abnormal liver function, changes in heart rhythm. Approved dosage: One pink 700mg tablet with one white 100mg tablet of ritonavir Resistance to darunavir: The drug works wel in many people with resistance to other protease inhibitors. Tips on taking it: Take with or without food. Key drug interactions: See the start of this Common side-effects: Raised lipids, section on protease inhibitors for more nausea, vomiting, diarrhoea, rash, abdominal information on possible interactions.
pain, headache, dizziness, tiredness, tingling around the mouth, changes in liver and pancreas function, lipodystrophy, liver toxicity, diabetes.
Names: Lopinavir/ritonavir, Kaletra Rare side-effects: Severe rash, changes in Note: Lopinavir is only available in combination heart rhythm.
Resistance to fosamprenavir: Is likely to cause Approved dosage: 400mg lopinavir plus 100mg resistance to ritonavir.
ritonavir twice a day, in yel ow tablets containing 200mg lopinavir and 50mg ritonavir; two Key drug interactions: See the start of this tablets are taken twice daily. Once-daily dose section on protease inhibitors for more of four yel ow tablets each containing 200mg information on possible interactions.
of lopinavir and 50mg ritonavir is available for people starting treatment for the first time. Do not take fosamprenavir with the anti-HIV drugs etravirine or tipranavir. Do not take Children: A Kaletra tablet containing 100mg of fosamprenavir with the anti-hepatitis drug lopinavir and 25mg of ritonavir is available for telaprevir or the antimalarial halofantrine.
use by children who can swal ow a tablet. A liquid formulation is also available. Tips on taking it: The tablet can be taken with Key drug interactions: See the start of this or without food, but must not be broken, section on protease inhibitors for more chewed or crushed. Taking with food can information on possible interactions.
reduce potential irritation of the stomach.
Efavirenz and nevirapine reduce levels of Common side-effects: Lipodystrophy, raised Kaletra and dose adjustments are sometimes liver enzymes, nausea, vomiting, diarrhoea, recommended when taking twice-daily abdominal pain, weakness, headache, Kaletra. Once-daily Kaletra should not usual y heartburn, raised lipids, liver toxicity, diabetes.
be taken together with either efavirenz or nevirapine. Kaletra should not be taken with Rare side-effects: Changes in heart rhythm. tipranavir/ritonavir or with darunavir.
Resistance to lopinavir/ritonavir: Likely Once-daily Kaletra should not be taken with cross-resistance with ritonavir and, to some carbamazepine, phenobarbital or phenytoin extent, fosamprenavir. High-level resistance (used to treat epilepsy).
to other protease inhibitors may reduce the effectiveness of lopinavir/ritonavir. Do not take Kaletra with the anti-hepatitis drug telaprevir; fentanyl (for pain relief); trazodone; Zyban; or anti-cancer drugs called tyrosine Tips on taking it: Take with food to reduce kinase inhibitors. nausea. Do not chew, break or crush tablets. Ritonavir tablets and liquid should always be stored at room temperature. Names: Ritonavir, Norvir Common (at full dose): Raised lipid and Approved dosage: Ritonavir was one of the liver enzymes, nausea, vomiting, diarrhoea, first protease inhibitors developed and is abdominal pain, headache, weakness, approved for use as an anti-HIV drug at a dose numbness around the mouth, bad taste in of 600mg twice a day. It is no longer used in mouth, lipodystrophy, liver toxicity, diabetes.
this way due to its side-effects. However, it is given at very low doses (too low for any HIV Common (at low dose): Raised lipid levels.
effect) to ‘boost' the level of other PIs. When used for its boosting effects, the dose Rare: Changes in heart rhythm.
of ritonavir is usually 100mg or 200mg once or twice daily (depending on the frequency with Resistance to ritonavir: Likely to be some which you take the protease inhibitor it resistance to fosamprenavir. is boosting).
Key drug interactions: See the start of this Tips on taking it: To be taken with food. section on protease inhibitors for more Tipranavir capsules should be stored in information on possible interactions.
the fridge, but can be kept at room temperature (below 25 degrees C) for up Ritonavir interacts with many other medications. Consult your doctor or HIV pharmacist before taking any other drugs with Common side-effects: Nausea, diarrhoea, ritonavir or a ritonavir-boosted drug (including vomiting, abdominal pain, tiredness, inhalers, nasal sprays, medicines bought from headache, fever, lipid increases, flatulence, a high-street chemist, herbal preparations and liver abnormalities, rash, lipodystrophy, recreational drugs). diabetes, liver toxicity.
Rare side-effects: Bleeding in brain, changes in Names: Tipranavir, Aptivus Approved dosage: Two 250mg pink capsules Resistance to tipranavir: Test-tube studies together with 200mg (two 100mg cream- report that resistance to tipranavir is slow to coloured tablets) ritonavir, twice daily. develop, and that there is no clear pattern of cross-resistance to currently available should be taken with the antifungal treatments protease inhibitors. itraconazole and ketoconazole, and high doses (more than 200mg a day) of these and Key drug interactions: See the start of this section on protease inhibitors for more information on possible interactions.
Tipranavir can reduce the effectiveness of abacavir and AZT. It's recommended that it not be taken with either of these drugs unless no other NRTI is available.
Some drugs can interact with tipranavir and change blood levels of one or both drugs,so dose adjustments may be needed. This is the case for: antidepressants; disulfiram (Antabuse); and the antibiotic metronidazole; anticonvulsants (used to treat epilepsy). Care Fusion inhibitors / CCR5 inhibitors
There is currently one drug in the fusion inhibitor class, cal ed T-20 (enfuvirtide, Names: Maraviroc, Celsentri Fuzeon). This is now only prescribed in very rare and specific circumstances. Anyone on Approved dosage: The dose of maraviroc is T-20 wil receive detailed information on the dependent on the other anti-HIV drugs you drug and how to use it from their doctor.
take. Your HIV doctor or pharmacist wil talk to you about which dose is appropriate for you. Most people wil take one blue tablet (300mg or 150mg) twice daily.
Note: Maraviroc should only be used by people with a type of HIV cal ed CCR5-tropic HIV. Not everybody has this type of virus; if you do not have it, you should not take maraviroc. Your HIV clinic should carry out a test called a tropism test to see if you CCR5 inhibitors
have CCR5-tropic HIV before prescribing Key drug interactions: Dose adjustment needed when maraviroc is taken with some other anti-HIV drugs. Tips on taking it: Take with or without food. If you are prescribed certain drugs, including Common side-effects: Nausea, diarrhoea, oral ketoconazole (not the shampoo), fatigue, headache. itraconazole and clarithromycin, your dose of maraviroc may need to be changed. Your Rare side-effects: Al ergic reaction including doctor or pharmacist will discuss this with you.
itchy rash, yel owing of the eyes, vomiting, dark urine and abdominal pain on the right People on the anti-TB drug rifampicin and on side; liver problems.
carbamazepine, phenobarbital and phenytoin (used to treat epilepsy) will need an adjusted Resistance to maraviroc: Resistance to dose of maraviroc. Your doctor or pharmacist maraviroc is stil being studied and appears will discuss this with you.
to occur in a different way to other anti-HIV drugs. St John's wort should not be taken with maraviroc. yel owing of the skin or eyes; dark urine; pale stools; or pain, aching or sensitivity on the right-hand side of the body, below the ribs. Names: Raltegravir, Isentress Common side-effects: Headache, insomnia. Dose: One pink 400mg tablet twice daily. Rare side-effects: Severe rash, hypersensitivity Tips on taking it: Take with or without food. reaction, extreme thirst (polydipsia).
Important warning: An allergic
Key drug interactions: If you are prescribed (hypersensitivity) reaction has been reported the TB drug rifampicin, your dose of raltegravir in some people using raltegravir. See your HIV may be increased to 800mg (two tablets) clinic immediately (or A&E if out of hours) if twice daily, as rifampicin can reduce drug levels you develop a rash together with any of these of raltegravir.
symptoms: fever; feeling general y unwel or extremely tired; muscle or joint ache; blistering of the skin; mouth ulcers; swel ing of the eye, lips, mouth or face; breathing difficulties; z ombinations of at least three anti-HIV drugs provide the best chance of reducing HIV treatment prevents HIV the amount of HIV in your blood to very low from damaging your immune system, and so levels (an undetectable viral load). prevents il health and prolongs lives. z aking your anti-HIV drugs as prescribed is z he best time to begin anti-HIV drugs is extremely important, as this wil prolong not known. Decisions are guided mainly by the benefit you will get from them, and the CD4 count and any symptoms that reduce the risk of resistance to the drugs you may have. General y, it is currently recommended that treatment starts before the CD4 count fal s below 350. Research z el a member of your HIV healthcare team continues to determine the best time to (doctor, nurse or pharmacist) if you are start HIV treatment.
having problems, including side-effects, with your anti-HIV drugs. Make sure they know z our doctor may recommend you start about any other medicines you are taking treatment when your CD4 cel count is (including those bought from a chemist, above 350 in some circumstances. herbal preparations and recreational drugs).
adherence The act of taking treatment exactly
immune system The body's mechanisms for
as prescribed, i.e. at the right times, with or fighting infection and getting rid of cel s that without food as needed.
are not working properly.
antiretroviral A medicine that acts against
lipodystrophy A disruption in the way the
retroviruses such as HIV.
body produces, uses and stores fat.
CD4 A molecule on the surface of some white
opportunistic infection Specific infections
blood cel s onto which HIV can bind. The CD4 that cause disease in someone with a damaged cel count roughly reflects the state of the immune system.
regimen A drug or treatment combination and
the way it is taken.
resistance A drug-resistant HIV strain is one
that is less susceptible to the effects of one or
more anti-HIV drugs.
undetectable viral load A level of viral load
too low to be picked up by the viral load test
being used. Achieving an undetectable viral
load is the aim of HIV treatment.
viral load Measurement of the amount of virus
in a sample of blood. HIV viral load is checked
to see if treatments are working.
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2ND ANNUAL FLORIDA RESIDENCY CONFERENCE May 9-10, 2013 University of Florida College of Pharmacy Gainesville, Florida Sponsored by the FSHP Research and Education Foundation 2ND ANNUAL FLORIDA RESIDENCY CONFERENCE Welcome to the Second Annual Florida Residency Conference. We are grateful to all in attendance and we are looking forward to another great conference full of high quality resident presentations, as well as some quality time with friends and colleagues. The Florida Residency Conference Steering Committee has been busy looking ahead to not only this conference but the future of the FRC.