Indications: HIV infection in combination with other antiretroviral drugs.

Cautions: Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes. Caution is also needed in patients with haemophilia who may be at increased risk of bleeding, also sulfonamide sensitivity; monitor liver function before and during treatment.

Contra-indications: acute porphyria

Hepatic impairment: should be used with caution in patients with chronic hepatitis B or C (increased risk of hepatic side effects).

Pregnancy: advises use only if potential benefit outweighs risk (if required, use the twice daily dose regimen).

Breast-feeding: by HIV-positive mothers may cause HIV infection in the infant and should be avoided.

Side Effects: MOST COMMON : peripheral neuropathy less commonly myocardial infarction, angina, QT interval prolongation, tachycardia, hypertension, flushing, peripheral oedema, dyspnea, cough, anxiety, memory impairment, depression, abnormal dreams, increased appetite, weight changes, pyrexia, hypothyroidism, osteoporosis, gynaecomastia, erectile dysfunction, reduced libido, dysuria, polyuria, nephrolithiasis, renal failure, arthralgia, dry eyes, conjunctivalhyperaemia, throat irritation, dry mouth, stomatitis, nail discoloration, acne, eczema, increased sweating, alopecia.

Dose: ADULT over 18 years previously treated with antiretroviral therapy 600 mg twice daily with low-dose ritonavir Or (if no resistance to darunavir, if plasma HIV- RNA concentration less than 100 000 copies/ml, and if CD4 cell count greater than 100 cells ×106/litre) 800 mg once daily with cobicistat or with low-dose ritonavir.

ADULT over 18 years not previously treated with antiretroviral therapy 800 mg once daily with cobicistat or with low-dose ritonavir.