TABLE 25.

Antiretroviral drug dose adjustments in renal failure.^86,87,88

Drug	CrCl†,§		Haemodialysis (dosage after dialysis)	Peritoneal dialysis
	10–50 mL/min	< 10 mL/min
TDF	Avoid	Avoid	300 mg once weekly	Unknown
ABC	Unchanged	Unchanged	Unchanged	Unchanged
3TC	150 mg daily	50 mg daily¶	50 mg first dose, thereafter 25 mg daily¶	50 mg first dose, thereafter 25 mg daily¶
AZT	Unchanged	300 mg daily	300 mg daily	300 mg daily
NNRTIs	Unchanged	Unchanged	Unchanged	Unchanged
PIs	Unchanged	Unchanged	Unchanged	Unchanged
InSTIs	Unchanged	Unchanged	Unchanged	Unchanged

Source: Bartlett JG, Gallant JE, Pham PA (eds). Medical management of HIV infection. 15th ed. Baltimore, MD: John Hopkins University Press, 2009–2010; 556 pp; Gilbert DN, Moellering RC, Eliopoulos GM, et al. (eds). The Sanford Guide to antimicrobial therapy. 42nd ed. Sperryville, Virginia: Antimicrobial Therapy, Inc., 2012; 232 pp; HIV Medicine Association of the Infectious Diseases Society of America. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update. Clin Infect Dis. 2014;59(9):e96–e138.

3TC, lamivudine; ABC, abacavir; ART, antiretroviral therapy; AZT, zidovudine; CrCl, creatinine clearance rate; d4T, stavudine; ddI, didanosine; eGFR, estimated glomerular filtration rate; InSTIs, integrase strand transfer inhibitors; MDRD, modification of diet in renal disease; NNRTIs, non-nucleoside reverse transcriptase inhibitors; PIs, protease inhibitors; NRTIs, nucleoside reverse transcriptase inhibitors; sCr, serum creatinine; TDF, tenofovir disoproxil fumarate.

^†, Many laboratories report the eGFR calculated using a variation of the MDRD formula. This result can be used (in place of the calculated CrCl) to make decisions regarding the use of TDF and for modification of the dose of other NRTIs based on this table.

^¶, Some experts recommend that the lowest available tablet dose of 150 mg 3TC daily should be used in patients with advanced renal disease (CrCl < 10 mL/min) and patients on dialysis so as to avoid having to use the liquid formulation of 3TC, and because of the favourable safety profile and lack of data to suggest 3TC dose-related toxicity. This is particularly relevant if the 3TC liquid formulation is unavailable or not tolerated.

^§, The modified Cockgraft–Gault equation: CrCl = (140 – age × ideal weight) ÷ sCr. For women, multiply the total by 0.85.