TABLE 23.

Prescribing antiretroviral therapy in liver impairment.

Class	Drug	Prescribing notes
NRTI	TDF	No dose adjustment necessary
	3TC	No dose adjustment necessary
	FTC	No dose adjustment necessary
	AZT	Decrease dose by 50% or double dosage interval in significant liver disease
	ABC	Reduce adult dose to 200 mg twice daily in significant liver disease Contraindicated in severe liver disease
InSTI	DTG	No data on recommendation for those with severe liver disease (Child–Pugh class C)
	RAL	No dose adjustment necessary
PI	DRV	Use with caution or avoid in significant liver disease
	ATV	Avoid in severe liver disease
	LPV/r	LPV is highly metabolised in the liver and concentrations may be increased in patients with hepatic impairment Therapeutic drug monitoring should be done if available
NNRTI	EFV	Not recommended in severe liver disease
	ETR	Use with caution in severe liver disease
	RPV	Use with caution in severe liver disease (Child–Pugh class C) – dose recommendation not established
CCR5 blocker	MVC	Concentrations likely to be increased with liver impairment

3TC, lamivudine; ABC, abacavir; ATV, atazanavir; ARVs, antiretrovirals; AZT, zidovudine; CCR5, C-C chemokine receptor type 5; DTG, dolutegravir; DRV, darunavir; EFV, efavirenz; ETR, etravirine; FTC, emtricitabine; InSTI, integrase strand transfer inhibitor; LPV, lopinavir; LPV/r, lopinavir/ritonavir; MVC, maraviroc; NNRTI, non-nucleoside reverse transcriptase inhibitors; NRTI, nucleoside reverse transcriptase inhibitors; PI, protease inhibitor; RAL, raltegravir; RPV, rilpivirine; TDF, tenofovir disoproxil fumarate.