Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

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.

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Appendix B: Drug Characteristics Tables

Antiretroviral Dosing Recommendations in Patients with Renal or Hepatic Insufficiency

Last Updated: October 25, 2018; Last Reviewed: October 25, 2018

Creatinine Clearance Calculation
Male:    (140 − age in years) x (weight in kg)
72 x (serum creatinine)
Female:     (140 - age in years) x (weight in kg) x (0.85)
72 x (serum creatinine)

Child-Pugh Score
Component Points Scored
1 2 3
Encephalopathya None Grade 1–2 Grade 3–4
Ascites None Mild or controlled by diuretics Moderate or refractory despite diuretics
Albumin >3.5 g/dL 2.8–3.5 g/dL <2.8 g/dL
Total bilirubin or <2 mg/dL (<34 µmol/L) 2–3 mg/dL (34–50 µmol/L) >3 mg/dL (>50 µmol/L)
Modified total bilirubinb <4 mg/dL 4–7 mg/dL >7 mg/dL
Prothrombin time (seconds prolonged) or <4 4–6 >6
International normalized ratio (INR) <1.7 1.7–2.3 >2.3
a Encephalopathy Grades
      Grade 1: Mild confusion, anxiety, restlessness, fine tremor, slowed coordination
      Grade 2: Drowsiness, disorientation, asterixis
      Grade 3: Somnolent but rousable, marked confusion, incomprehensible speech, incontinence, hyperventilation
      Grade 4: Coma, decerebrate posturing, flaccidity

b Modified total bilirubin is used for patients who have Gilbert’s syndrome or who are taking indinavir or atazanavir.

Child-Pugh Classification Scores
Child-Pugh Classification Total Child-Pugh Scorea
Class A 5–6 points
Class B 7– points
Class C >9 points
a Sum of points for each component of the Child-Pugh Score

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