Lopinavir Zidovudine

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... 

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. 

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... 

Fosamprenavir Abacavir, atazanavir, delavirdine, etravirine, indinavir, lopinavir, ritonavir, tipranavir, zidovudine Didanosine, efavirenz, nevirapine, saquinavir... 

Oral (Epivir) 150, 300 mg tablets 10 mg/mLoral solution Oral (Epivir-HBV) 100 mg tablets 5 mg/mL solution Oral (Combivir) 150 mg tablets in combination with 300 mg zidovudine Oral (Trizivir) 150 mg tablets in combination with 300 mg abacavirand 300 mg zidovudine Lopinavir/ritonavir (Kaletra)... 

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

Indinavir Delavirdine, lopinavir, nelfinavir, zidovudine Amprenavir, delavirdine, efavirenz, nevirapine, ritonavir... 

ZIDOVUDINE LOPINAVIR + RITONAVIR i efficacy of zidovudine 1 plasma levels by t glucu-ronidation Avoid co-administration... 

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. ... 

Clinically important, potentially hazardous interactions with alprazolam, aprepitant, astemizole, atorvastatin, benzodiazepines, carbamazepine, chlordiazepoxide, cilostazol, clonazepam, clorazepate, colchicine, conivaptan, cyclosporine, dabigatran, dasatinib, diazepam, digoxin, dihydroergotamine, disopyramide, ergot alkaloids, fesoterodine, fluoxetine, flurazepam, fluvastatin, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lorazepam, lovastatin, methylprednisolone, methysergide, midazolam, nilotinib, oxazepam, paroxetine, pimozide, pravastatin, prednisone, quazepam, repaglinide, rimonabant, rivaroxaban, sertraline, silodosin, simvastatin, solifenacin, temazepam, temsirolimus, tolvaptan, trabectedin, triazolam, warfarin, zidovudine... 

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-... 

In a placebo-controlled study in healthy subjects, efavirenz 600 mg once daily for 14 days reduced the steady-state AUC and maximum plasma level of maraviroc 100 mg twice daily by about 50%. Doubling the dose of maraviroc to 200 mg twice daily overcame this increase in metabolism, resulting in a minor 10% increase in AUC and 20% increase in maximum level, when compared with maraviroc 100 mg twice daily alone. Similarly, in another study, the AUC of a single 300-mg dose of maraviroc was about 50% lower in two groups of 8 patients one group taking efavirenz, lami vudine and zidovudine and the other taking efavirenz, didanosine and tenofovir. When efavirenz 600 mg daily was added to lopinavir/ritonavir 400/100 mg twice daily with maraviroc 300 mg twice daily, the increase in maraviroc AUC seen with these protease inhibitors , (p.780), was reduced from about 300% to about 150%, when compared with the AUC for maraviroc alone. Similarly, when efavirenz 600 mg daily was added to saquinavir/ritonavir 1000/100 mg twice daily with maraviroc 100 mg twice daily, the increase in maraviroc AUC seen with these protease inhibitors was reduced from 877% to 400%, when compared with the AUC for maraviroc alone. ... 

Lopinavir/Ritnnavir. The manufacturer of lopinavir/ritonavir notes that it induces glucuronidation and therefore has the potential to reduce zidovudine levels. However this, and its clinical relevance, have yet to be studied. ... 

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. 

Combination of 16 ARVs seven HIV protease inhibitors (amprenavir, atazanavir, indinavir, lopinavir, nelfmavir, ritonavir, and saquinavir), seven nucleoside reverse transcriptase inhibitors (abacavir, didanosine, emtricitabine, lamivudine, stavudine, zalcitabine, and zidovudine), and two nonnucleoside reverse transcriptase inhibitors (efavirenz and nevirapine)... 

Zidovudine The differential effects of antiretroviral drugs on body fat disposition have been studied in 50 HTV-1 infected men in a randomized single-blind comparison of zidovudine + lamivudine with lopinavir + ritonavir and nevirapine with lopinavir + ritonavir [67 ]. In those who took the zidovudine-based therapy limb fat fell progressively from 3 months onward by a mean of 684 g up to 24 months, whereas abdominal fat increased, but exclusively in the visceral compartment. In contrast, in those who took nevirapine-based therapy there was a generalized increase in fat mass. After 24 months there were no significant differences in HDL cholesterol and the total/HDL cholesterol ratio, but total and low density lipoprotein (LDL) cholesterol were higher in those who had taken nevirapine. 

Musculoskeletal Changes in bone mineral density and bone turnover have been studied in 50 patients taking lopinavir -f ritonavir with either zidovudine - - lamivudine or nevirapine [78 ]. Bone mineral density rapidly fell in both the femoral neck and lumbar spine after the start of therapy, and there was greater loss after 24 months in those who took zidovudine -I- lamivudine. Osteocalcin and the urine deoxypyridinolinexreatinine ratio increased to the same extent in both groups. Changes in parathyroid hormone did not explain the greater bone loss with zidovudine + lamivudine. 

In a comparison of changes in bone mineral density in 106 HIV-1 infected, antiretroviral drug-naive patients, who were randomized to zidovudine -i- lamivudine with either efavirenz n = 32) or lopinavir + ritonavir n = 74) for 96 weeks, the mean changes from baseline in total bone mineral density were -2.5% (lopinavir -I- ritonavir) and -2.3% (efavirenz) [79 . The authors concluded that loss of bone mineral density during antiretroviral drug therapy is independent of the drug regimen. 

Cardiovascular system Acute congestive heart failure and fatal asystole have been attributed to itraconazole [16 ]. A 22-year-old-man with asymptomatic HTV infection treated with zidovudine, lamivudine and lopinavir/ritonavir was treated with itraconazole (200 mg three hmes daily for 2 days followed by 200 mg twice daily) after initial improvement from Histoplasma capsulatum infection requiring ICU treatment. 

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