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 16, 2019; Last Reviewed: April 16, 2019
|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.||In adults, elevated urine pH (>5.7)
The risk factors in children are unknown.
||Provide adequate hydration and pain control. Consider using another ARV 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. For patients taking TDF, some Panel members routinely monitor serum phosphate levels.
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||Onset:
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.
|N/A||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 to Acronyms: ARV = antiretroviral; ATV = atazanavir; 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|