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

FI

ARV Dose Adjustment
ENF No dosage adjustment

CCR5 Inhibitor

ARV Dose Adjustment
MVC No dosage recommendations. Concentrations will likely be increased in persons with hepatic impairment

INSTI

Agent Dose Adjustment
RAL No dosage adjustment
EVG Child-Pugh Class A or B: no dosage adjustment
Child-Pugh Class C: no data
DTG Child-Pugh Class A or B: no dosage adjustment
Child-Pugh Class C: no data
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
TDF/FTC/EVG/c Child-Pugh Class A or B: no dosage adjustment
Child-Pugh Class C: no data
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

Note: Hepatic dysfunction is a good indication for TDM as clinical experience with these dose adjustments is very limited