Guidelines to Antiretroviral Drug Therapy in Kenya: APPENDICES: I. Drug to drug interactions

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	Guidelines to Antiretroviral Drug Therapy in Kenya (WHO; 2001; 78 pages)
		FOREWORD
		ACKNOWLEDGMENT
		CHAPTER ONE: INITIATING ANTIRETROVIRAL THERAPY
			1.1 Introduction
			1.2 Guidelines to making a diagnosis of HIV infection
			1.3 Laboratory Diagnosis of HIV infection
			1.4 Goals of therapy
			1.5 When to start therapy
			1.6 Risks and benefits of delayed initiation of therapy and of early therapy in the Asymptomatic HIV-Infected Patient
			1.7 Antiretroviral profile
			1.8 What drug combination to start with?
		CHAPTER TWO: MONITORING AND CHANGING THERAPY
			2.1 Surrogate markers
			2.2 Resistance testing
			2.3 How often should CD4 Cell Count and Viral Load be performed (Frequency)
			2.4 Treatment failure
			2.5 Reasons for non-adherence
			2.6 Considerations for changing a failing regimen
			2.7 Guidelines for changing an antiretroviral regimen for suspected drug failure
			2.8 Potential options for changing therapy*
		CHAPTER THREE: PHARMACOTHERAPEUTICS OF ARVS
			3.1 Characteristics of available antiretroviral drugs
			3.2 Pharmacokinetic properties of Antiretrovirals
		CHAPTER FOUR: GUIDELINES FOR THE USE OF ANTIRETROVIRAL DRUGS IN PAEDIATRIC HIV INFECTION
			4.1 Overview
			4.2 Diagnosis of HIV infection in children
			4.3 When to initiate treatment
			4.4 Initiation of treatment
			4.5 Agents to choose for initial treatment
			4.6 Dosages for paediatric formulations
			4.8 Monitoring
			4.9 When to change therapy
		CHAPTER FIVE: MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTED PREGNANT WOMEN AND PREVENTION OF MOTHER TO CHILD TRANSMISSION (MTCT) OF HIV
			5.1 Overview
			5.2 Factors affecting mother to child transmission
			5.3 Outline antenatal, intrapartum postpartum and postnatal care
			5.4 Antiretroviral Therapy to prevent MTCT
		CHAPTER SIX: SPECIAL CONSIDERATIONS
			6.1 Acute retroviral syndrome (ARVS)
			6.2 ARV drugs and the treatment of Tuberculosis
			6.3 Immune recovery syndrome
		CHAPTER SEVEN: WHEN TO STOP TREATMENT (INTERRUPTIONS)
			7.1 Structured treatment interruptions (STI's)
			7.2 Non structured treatment interruption
		CHAPTER EIGHT: GUIDELINES FOR POST EXPOSURE PROPHYLAXIS
			8.1 Treatment of exposure sites
			8.2 Timing of post - HIV exposure prophylaxis initiation
			8.3 Assessment of exposure risk
			8.4 Post - HIV exposure prophylaxis
			8.5 Recommended HIV serology after exposure
			8.6 Management of health care workers with accidental exposure to HIV infection
			8.7 Management of hospital staff with sharp injury or exposure to blood and body fluids
			8.8 Management of non occupational exposure to HIV infection
			8.9 Management of non-sexual and non occupational Exposures to HIV
		CHAPTER NINE: ACCESS TO DRUGS IN KENYA
		APPENDICES
			I. Drug to drug interactions
			II. Drug to drug interactions (continued)
			III. Drug Interactions Between Antiretrovirals and Other Drugs
			IV. Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
			V. Drug Interactions: Protease Inhibitors
			VI. Drug Interactions: Protease Inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors - Cont.
			VII. Drug That Should Not be Used With Antiretrovirals
			VIII. Drugs that should not be used with Protease Inhibitors Antiretrovirals
			IX. HIV-related drugs with overlapping toxicities
			X. Anti-retroviral therapy for preventing MTCT
		BACK COVER

I. Drug to drug interactions

Drugs Affected	Amprenavir (APV)	Lopinavir (LPV)	Nelfinavir (NFV)
ANTIFUNGALS Ketoconazole	Levels: APV increases 31% 3X Ketor reduces 44%	Levels: LPV AUC decreases 13% Keto increases 3-fold.	No dose adjustment necessary
ANTI-MYCOBACTERIALS Rifabutin	Levels: APV AUC decreases 82%. No change in rifabutin AUC Avoid concomitant use.	Levels: LPV AUC decreases 75% Avoid concomitant use.	Level: 82% Contraindicated
Rifabutin	Levels: APV AUC decreases 15% Rifabutin increases 193% Dose: No change in APV dose Decrease Rifabutin to 150mg qds or 300mg 2-3x/week	Levels: Rifabutin AUC increases 3-fold. Decrease Rifabutin dose to 150mg gds	Levels: NFV 32% Rifabutin increases 2X Dose: Increase Rifabutin to 150mg qd Decrease NFV dose to 1000 mg tid.
Clarithromycin	Levels: APV AUC increase 18%. No change in clarithromycin AUC No dose adjustment	No data	No data
ORAL CONTRACEPTIVES	Levels: Potential for metabolic interactions use alternative or additional methods	Levels: Ethinylestradiol decreases 42% Use alternative or additional methods.	Levels: Norethindrone 18% Ethinylestradiol 47% Use alternative or additional method.
LIPID LOWERING AGENTS Simvastatin Lovastatin	Levels: Potential for large increase in statin levels. Avoid concomitant use	Levels: Potential for large increase in statin levels. Avoid concomitant use	Levels: Potential for large increase in statin levels. Avoid concomitant use
ANTICONVULSANTS Phenobarbitol Phenytoin Carbamazephine	Unknown but may decrease APV levels substantially Monitor anticonvulsant level.	Unknown but may decrease LPV levels substantially Monitor anticonvulsant level.	Unknown but may decrease NFV levels substantially Monitor anticonvulsant level.

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