Antiretrovirals for the treatment of HIV in Acute
Key messages
- Many antiretrovirals (ARVs) have a high potential for drug interactions. Standard sources of information on interactions are insufficient. ALWAYS check specialist interaction sources for any new medicines prescribed, including inhaled/topical medicines and even supplements and enteral feeds. (See ‘more information’ below).
- Drug interactions that result in reduced plasma levels of ARVs can have serious consequences including treatment failure, resistance and limitation of already restricted treatment options.
- For medicines reconciliation, DO NOT rely on information on ECS as the medicines are not prescribed by the GP and ARVs may not be listed on ECS or may not be up to date. Each patient’s clinical portal record contains electronic case notes (Patients Notes – Infectious Diseases Specialty) and copies of ARV prescriptions (Clinical Documents tab under Medication).
- Use patient’s own supply. If unavailable, place an urgent order via usual medication supply route. To avoid delayed/missed doses Ward 5C at QEUH keep stock of all ARVs.
- ARVs should not have doses omitted without good reason. Ensure medicines are available and appropriately prescribed and administered.
- Prescribe and administer ARVs at the correct time each day, confirming with the patient what time they usually take doses at. Timing should be consistent to ensure drug levels remain in an effective range.
- Specify whether ARVs should be taken with food or a meal as this may affect bioavailability.
- If patients are on more than one ARV preparation, ensure all preparations are prescribed and administered. Do not administer part of a regimen as sub-optimal treatment may lead to resistance.
- If clinical condition warrants review of medicines and on assessment current ARVs are not appropriate, contact an HIV specialist for advice straight away.
FOR MORE INFORMATION
- Specialist sources such as the University of Liverpool HIV Drug interactions website, https://www.hiv-druginteractions.org/ must be checked to identify potential interactions when any new medicines are prescribed. The full desktop version, as opposed to the mobile app, is preferred as it may contain additional information relevant to decision making.
- If supply is required out of hours, obtain via QEUH clinical co-ordinator.
- For any queries within normal hours, contact HIV pharmacy service at Gartnavel General on 0141 211 3383 (53383).
- More information on the treatment of HIV infection is in the British HIV Association treatment guideline available at https://www.bhiva.org/HIV-1-treatment-guidelines and in the BNF (please note, accessing the online BNF outwith an NHS network may require a log in).
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Originally published 22/01/19 and updated 01/12/21. Medicines Update blogs are correct at the time of publication.