Lopinavir Lamivudine

Zidovudine Didanosine Stavudine Lamivudine Abacavir Tenofovir Emtricitabine Nevirapine Efavirenz TMC125 Saquinavir Indinavir Lopinavir Fosamprenavir Atazanavir Tipranavir Darunavir Raltegravir Elvitegravir Enluvirtide Maraviroc Vicriviroc Bevirimat... 

Tenofovir + Emtricitabine Zidovudine + Lamivudine Abacavir + Lamivudine Efavirenz or Nevirapine Lopinavir/r or Atazanavir/r or Eosamprenavir/r or Saquinavir/r... 

Lopinavir/ritonavir, and abacavir or stavudine or tenofovir or didanosine, and lamivudine or emtricitabine... 

TC, lamivudine ABC, abacavir APV, amprenavir AST, aspartate aminotransferase ALT, alanine aminotransferase ATV, atazanavir CBC, complete blood cell count D/C, discontinue ddl, didano-sine d4T, stavudine EFV, efavirenz FTC, emtricitabine P1BV, hepatitis B virus F1CV, hepatitis C vims HIV, human immunodeficiency virus IDV, indinavir IV, intravenous LFT, liver function tests LPV/r, lopinavir + ritonavir NNRTI, nonnucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor NVP, nevirapine PI, protease inhibitor PT, prothrombin time T.bili, total bilirubin TDF, tenofovir disoproxiI fumarate TPV, tipranavir ULN, upper limit of normal ZDV, zidovudine. 

Lopinavir/ritonavir or atazanavir/ritonavir and (zidovudine or fosamprenavir/ritonavir or tenofovir) and (lamivudine or emtricitabine). 

Current recommendations for treating HIV infection advocate a minimum of three antiretroviral agents. The typical regimen consists of two NtRTIs and either a ritonavir-boosted PI or NNRTI. The dual NtRTI backbone should include tenofovir plus emtricitabine (coformulated as Truvada) or zidovudine plus lamivudine (coformulated as Combivir). Abacavir plus lamivudine is an alternative. Recommended initial NtRTIs include atazana-vir-ritonavir, lopinavir-ritonavir, or fosamprenavir-ritonavir. Efavirenz is the recommended NNRTI except for women who plan to become pregnant or who do not have adequate contraception. 

Lamivudine (Epivir, Epivir-HBV) Lopinavir/Ritonavir (Kaletra)... 

TC Lamivudine ABC Abacavir d4T Stavudine ddC Zalcitabine ddl Didanosine TDF Tenofovir ZDV Zidovudine, also abbreviated as AZT FTC Emtricitabine NVP Nevirapine DLV Delavirdine EFV Efavirenz RTV, r Ritonavir Pl/r Ritonavir boosted protease inhibitor SQV Saquinavir IDV Indinavir LPV Lopinavir NEV Nelfinavir APV Amprenavir ATV Atazanavir DRV Darunavir... 

Preferred regimen Efivarenz Atazanavir + ritonavir Fosamprenavir + ritonavir Lopinavir/ ritonavir Tenofovir/ emtricitabine Zidovudine/ lamivudine... 

An active transport mechanism has long been suspected to account for the placental barrier that causes maternal and fetal concentrations for many drugs to differ (96 97). Studies of maternal-fetal transport of medications used during pregnancy in HIV-positive women have shown variable penetration into the fetus (98 99). Whereas the maternal-fetal drug ratios for zidovudine lamivudine/ and nevirapine (approximately 0.85 1.0/ and 0.9/ respectively) demonstrate good fetal penetration/ most protease inhibitors/ nelhnavir/ ritonavh/ saquinivir/ and lopinavir/ are known P-gp substrates and do not cross the placenta in detectable levels (98). 

Preferred Pl-based regimens are lopinavir/ritonavir plus lamivudine or emtricitabine plus another NRTI, usually zidovudine, stavudine or abacavir. Alternative combinations include other Pis with or without ritonavir, and two NRTIs. The combination of a protease inhibitor with ritonavir provides inhibition of cytochrome p450 enzymes and permits less frequent dosing of amprenavir, indinavir, lopinavir and saquinavir. Use of ritonavir in this setting is also known as boosting. ... 

HPI CJ is a 32-year-old man with acquired immunodeficiency syndrcMne (AIDS) (CD4+ cell count 160 cells/mm viral load 35,000 copies/mL) who presents to the clinic with altered taste sensation and difficulty swallowing. G is noted to have white plaques on the tongue and upper oral pharynx that are easily scraped off with a tongue depressor. PMH is significant for renal insufficiency secondary to his HIV. His antiretroviral regimen includes stavudine, lamivudine, and lopinavir/ritonavir and he is receiving TMP-SMX for Pneumocystis carinii pneumonia (PCP) prophylaxis. He has NKDA. 

GR is a 55-year-old HIV positive man currently receiving ritonavir/lopinavir, nevirapine, and lamivudine. You would like to start simvastatin to decrease his triglycerides. Which of his ARVs will interact with simvastatin ... 

E Simvastatin is metabolized by CYP3A4. Nevirapine is an inducer of CYP3A4, whereas lopinavir and ritonavir are inhibitors of CYP3A4. Thus, the effect of these two drugs on simvastatin levels is unpredictable. Lamivudine is not metabolized by the CYP450 system and will not affect simvastatin levels. 

Preferred Lopinavir/ritonavir plus lamivudine plus zidovudine (or stavudine)... 

Atazanavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine) Indinavir-ritonavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine) Lopinavir-ritonavir p/us emtricitabine plus zidovudine (or stavudine)... 

ABBREVIATIONS EFV, efavirenz 3TC, lamivudine AZT, zidovudine TDF, tenofovir disoproxil fumarate d4T, stavudine LPV/r, lopinavir/ritonavir coformulation FTC, emtricitabine NVP, nevirapine ddl, didanosine ATV, atazanavir fosAPV, fosamprenavir RTV, ritonavir IDV, indinavir NFV, nelfinavir SQV, saquinavir. 

A 55-year-old HIV-positive man who was taking zidovudine, lamivudine, ahaeavir, nevirapine and ritonavir-hoosted lopinavir experieneed unex-peeted severe gastrointestinal and haematological toxicities and moderate renal failure after the seeond and third intravenous injections of vinblastine 10 mg given to treat multicentric Castieman s disease (MCD). Subsequently, the antiretrovirals were stopped and the patient did not experience these toxicities when vinblastine was given alone. When the MCD was un-... 

Rifabutin 300 to 600 mg daily for 12 days did not significantly affect the pharmacokinetics of [buffered] didanosine 167 to 250 mg twice daily in 12 patients with AIDS. The steady-state pharmacokinetics of rifabutin were not affected by didanosine (buffered sachet preparation), which suggests that the buffer used in the didanosine preparation had no effect on rifabutin absorption. However, a case has been reported of a patient taking lopinavir/ritonavir, efavirenz, lamivudine and buffered didanosine who had impaired rifabutin absorption. When rifabutin was taken 30 minutes after didanosine, rifabutin levels were undetectable, but when rifabutin was taken 3 hours after didanosine, rifabutin levels were apparent. ... 

Lamivudine metabolism does not involve the cytochrome P450 isoenzyme CYP3A4. Therefore it is unlikely that it will interact with drugs, such as the protease inhibitors, whieh are metabolised by this system. No pharmacokinetic interaction appears to oeeur between lamivudine and amprenavir, - atazanavir, -" indinavir, and nelfinavir. The manufacturer of lopinavir/ritonavir notes that lamivudine did not alter the pharmacokinetics of lopinavir, - and tipranavir plus low-dose ritonavir did not cause a signifieant ehange in the AUC of lamivudine. - ... 

An HIV-positive patient who had a serum carhamazepine level of 10.3 mg/L while taking carbamazepine 400 mg three times daily reported feeling very drowsy within 9 days of starting to take tenofovir, lamivudine and lopinavir/ritonavir 400/100 mg twice daily. His carhamazepine serum level was found to have increased by 46%, to 15 mg/L. The carbamazepine dose was reduced to 400 mg twice daily, and 2 days later the carbamazepine level was 7.4 mg/L. ... 

However, there is one report of a possible decrease in valproate levels in a 30-year-old man after starting lopinavir/ritonavir. This patient, who had been taking valproic acid 375 mg daily as divalproex sodium for 7 months after an episode of mania, had a subtherapeutic valproic acid level of 197 micromol/L, and the dose was increased to 250 mg three times daily. After 25 days his trough valproic acid level was 495 micromol/L, and an antiretroviral regimen of lamivudine, zidovudine, lopinavir/ritonavir was started, and paroxetine for depression. Four days later he was hy-pomanic and the paroxetine was replaced with sertraline, which the patient discontinued. Twenty-one days later he had become increasingly manic, and the valproic acid level was found to be 238 micromol/L, about 50% lower than the previous level. An increase in valproic acid dose to 1.5 g daily was eventually required to achieve a therapeutic level of 392 micromol/L. 

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