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ARV Dosing: Hepatic Impairment
Dose Adjustment of ARVs for Impaired Hepatic Function
Dose adjustment of ARVs for persons with impaired hepatic function
NRTIs
| ARV | Dose Adjustment |
|---|---|
| ABC | Child-Pugh Class A: 200 mg bid (use oral solution) Child-Pugh Class B or C: contraindicated |
| FTC | No dosage adjustment |
| 3TC | No dosage adjustment |
| TAF | No dosage adjustment |
| TAF/FTC | No dosage adjustment |
| TDF | No dosage adjustment |
| TDF/FTC | No dosage adjustment |
| ZDV | Reduce dose by 50% or double the interval between doses if Child-Pugh Class C |
NNRTIs
| ARV | Dose Adjustment |
|---|---|
| EFV | No dosage adjustment; use with caution in persons with hepatic impairment |
| TDF/FTC/EFV | No dosage adjustment; use with caution in persons with hepatic impairment |
| ETV | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
| NVP | Child-Pugh Class B or C: contraindicated |
| RVP | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
| TAF/FTC/RPV | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
| TDF/FTC/RPV | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
| TDF/3TC/DOR | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
| DOR | Child-Pugh Class A or B: no dosage adjustment Child Pugh Class C: no data |
PIs
| ARV | Dose Adjustment |
|---|---|
| ATV | Child-Pugh Class A: no dose adjustment Child-Pugh Class B: 300 mg qd (unboosted) Child-Pugh Class C: not recommended |
| ATV/c | Child-Pugh Class A: no dosage adjustment Child-Pugh Class B or C: not recommended |
| COBI | Refer to recommendations for the primary PI |
| DRV | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: not recommended |
| DRV/c | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: not recommended |
| TAF/FTC/DRV/c | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: not recommended |
| LPV/r | No dosage recommendation; use with caution in persons with hepatic impairment |
| RTV | Refer to recommendations for the primary PI |
AI
| ARV | Dose Adjustment |
|---|---|
| FTR | No dosage adjustment |
FI
| ARV | Dose Adjustment |
|---|---|
| ENF | No dosage adjustment |
EI
| ARV | Dose Adjustment |
| Ibalizumab | No dosage adjustment |
CCR5 Inhibitor
| ARV | Dose Adjustment |
|---|---|
| MVC | No dosage recommendations. Concentrations will likely be increased in persons with hepatic impairment |
Capsid Inhibitor
| ARV | Dose Adjustment |
|---|---|
| LEN |
Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, use with caution |
INSTI
| Agent | Dose Adjustment |
|---|---|
| RAL | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, use with caution |
| EVG | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| DTG | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, use with caution |
| DTG/3TC |
Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, use with caution |
| DTG/RPV | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| BIC | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| TAF/FTC/EVG/c | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| TDF/FTC/EVG/c | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| ABC/3TC/DTG | Use separate compounds and refer to those adjustments |
| TAF/FTC/BIC | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data, not recommended |
| CAB | Child-Pugh Class A or B: no dosage adjustment Child-Pugh Class C: no data |
Note: Hepatic dysfunction is a good indication for TDM as clinical experience with these dose adjustments is very limited