Renal impairment (CrCl <50 mL/min). Mild to moderate hepatic impairment. High risk for hypersensitivity reactions in patients w/ HLA-B*5701 allele +ve result. Perform screening for carriage of HLA-B*5701 allele prior to initiating treatment. Permanently discontinue if hypersensitivity cannot be ruled out; closely monitor patients especially during the 1st 2 mth of treatment w/ consultation every 2 wk. Do not restart therapy in patients who stopped treatment due to hypersensitivity. Concomitant use w/ drugs known to induce skin toxicity eg, NNRTIs, & abacavir-containing drugs eg, Ziagen, Trizivir; tenofovir disoproxil fumarate. Lactic acidosis; patients w/ hepatomegaly, hepatitis or other known risk factors for liver disease & hepatic steatosis; co-infected w/ hepatitis C & treated w/ α interferon & ribavirin; discontinue in symptomatic setting of hyperlactatemia & metabolic/lactic acidosis, progressive hepatomegaly, or rapidly elevating aminotransferase levels. Lipodystrophy. Pancreatitis. Patients w/ significant underlying liver disorders; chronic hepatitis B or C & receiving combination retroviral therapy. Periodic monitoring of LFTs & HBV replication markers in patients co-infected w/ HBV discontinued therapy. Mitochondrial dysfunction in HIV -ve infants exposed
in utero & post-natally to nucleoside analogues. Immune reactivation syndrome. Osteonecrosis. Opportunistic infections may still develop. MI. Pregnancy & lactation. Elderly >65 yr. Childn <12 yr.
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