Nucleoside reverse transcriptase inhibitors

Indications: HIV infection in combination with other antiretroviral drugs; prevention of maternal-fetal HIV transmission.

Cautions: haematological toxicity particularly with high dose and advanced disease—monitor full blood count after 4 weeks of treatment, then every 3 months; vitamin B12 deficiency (increased risk of neutropenia); if anaemia or myelo suppression occur, reduce dose or interrupt treatment according to product literature, or consider other treatment; elderly;

Contra-indications: abnormally low neutrophil counts or haemoglobin concentration, neonates with hyperbilirubinaemia requiring treatment other than phototherapy, or with raised transaminase, acute porphyria

Hepatic impairment: accumulation may occur

Renal impairment: reduce oral dose to 300–400 mg daily in divided doses or intravenous dose to 1 mg/kg 3–4 times daily if eGFR is less than 10 ml/minute/1.73 m2; avoid Combivir (or non-proprietary equivalents) if eGFR less than 50 ml/minute/1.73m2.

Pregnancy: Treatment of HIV infection in Pregnancy aims to reduce the risk of toxicity to the fetus (although information on the teratogenic potential of most antiretroviral drugs is limited), to minimise the viral load and disease progression in the mother, and to prevent transmission of infection to the neonate. All treatment options require careful assessment by a specialist.

Combination antiretroviral therapy maximises the chance of preventing transmission and represents optimal therapy for the mother. However, it may be associated with a greater risk of preterm delivery. Pregnancies in HIV- positive women and babies born to them should be reported prospectively to the National Study of HIV in pregnancy and Childhood and to the Antiretroviral pregnancy Registry.

Mitochondrial dysfunction has been reported in infants exposed to nucleoside reverse transcriptase inhibitors in utero; the main effects include haematological, metabolic, and neurological disorders; all infants whose mothers received nucleoside reverse transcriptase inhibitors during pregnancy should be monitored for relevant signs or symptoms.

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

Dose: 1 tablet twice daily

child body-weight over 14 kg

Note: Tablets may be crushed and mixed with semi- solid food or liquid just before administration