Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Medication Toxicity or Intolerance
Last Updated: April 14, 2020; Last Reviewed: April 14, 2020
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/Monitoring||Management|
DRV causes crystalluria, but it is not associated with nephrolithiasis.
||ATV-related nephrolithiasis occurs in <10% of patients and has been reported after stopping ATV.||In adults, elevated urine pH (>5.7)
The risk factors in children are unknown.
||Provide adequate hydration and pain control. Consider using another ARV drug in place of ATV.|
||Risk May Increase in Children with the Following Characteristics:
||Monitor urine protein, urine glucose and serum creatinine at 3-month to 6-month intervals. Some Panel members routinely monitor serum phosphate levels in patients who are taking TDF.
Measure serum phosphate if the patient experiences persistent proteinuria or glucosuria, or has symptoms of bone pain, muscle pain, or weakness.
Because toxicity risk increases with the duration of TDF treatment, do not decrease the frequency of monitoring over time.
|If TDF is the likely cause, consider using an alternative ARV drug. TAF has significantly less toxicity than TDF.|
|Elevation in Serum Creatinine||DTG, COBI, RPV, BIC||Onset:
Clinicians need to distinguish between a true change in eGFR and other causes. A true change may be associated with other medical conditions, the continuing rise of serum creatinine levels over time, and albuminuria.
|The risk factors in children are unknown.||Monitor serum creatinine. Assess for renal dysfunction if serum creatinine increases by >0.4 mg/dL or if increases continue over time.||No need to change therapy.
Reassure the patient about the benign nature of the laboratory abnormality.
|Key: ARV = antiretroviral; ATV = atazanavir; BIC = bictegravir; COBI = cobicistat; dL = deciliter; DRV = darunavir; DTG = dolutegravir; eGFR = estimated glomerular filtration rate; LPV/r = lopinavir/ritonavir; PI = protease inhibitor; RPV = rilpivirine; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate|