Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
Management of Medication Toxicity or Intolerance
Last Updated: April 27, 2017; Last Reviewed: April 27, 2017
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Urolithiasis/ Nephrolithiasis||ATV, IDV
DRV causes crystalluria, but is not associated with increased nephrolithiasis.
ATV-related nephrolithiasis occurs in <10%.
IDV-related higher (29%) in children than adults (12.4%)
|In adults, elevated urine pH (>5.7)
Unknown in children
||Provide adequate hydration and pain control; consider using alternative ARV. If on IDV, discontinue.|
||Risk May Be Increased in Children:
||Monitor urine protein and glucose or urinalysis, and serum creatinine at 3- to 6-month intervals. For patients taking TDF, some panelists add serum phosphate to the list of routine labs to monitor.
In the presence of persistent proteinuria or glucosuria, or for symptoms of bone pain or muscle pain or weakness, also measure serum phosphate.
Because toxicity risk increases with duration of TDF treatment, frequency of monitoring should not decrease with time.
|If TDF is the likely cause, consider using alternative ARV. TAF has significantly less toxicity than TDF.|
|Elevation in Serum Creatinine||DTG, COBI, RPV||Onset:
Need to distinguish between true change in eGFR and other causes. True change might be associated with other medical conditions, continuing rise of serum creatinine with time, and albuminuria.
|N/A||Monitor serum creatinine. Assess for renal dysfunction if serum creatinine increases by >0.4 mg/dL or increases are ongoing with time.||No need to change therapy.
Reassure patient about the benign nature of the laboratory abnormality.
|Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; COBI = cobicistat; ddI = didanosine; DRV = darunavir; DTG = dolutegravir; eGFR = estimated glomerular filtration rate; FDA = Food and Drug Administration; IDV = indinavir; LPV/r = boosted lopinavir/ritonavir; PI = protease inhibitor; RPV = rilpivirine; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate|
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