It seems like many ARVs haven't been well studied in cirrhotic patients. But I'm often using them anyway in compensated cirrhosis, despite warnings. I've seen a few studies mildly reassuring about certain meds, e.g. RAL, but mixed reviews even about TDF/TAF. So, other than ABC, what ARVs are to be avoided in cirrhosis?
Here's my current case:
HIV+ man in his late 60s with complex medical hx - incl HF with pulmonary hypertension (on sildenafil), severe emphysema, and stable cirrhosis with encephalopathy, esophageal varices (on PPI), icterus, and thrombocytopenia (now s/p HCV tx and sober). HIV well controlled on Intelence/Isentress/Prezista/norvir x 10+ years and interested in simplifying. Past genotype includes 184V, 67N, 70R, 219Q and 84V, 90M.
I don't see a perfect option. He's been on DRV and several meds w RTV/CYP3 interactions (sildenafil, inhaled corticosteroid, tamsulosin) x years, so maybe I could keep DRV and switch booster to cobi? But probably better to stop the PI+booster given these interactions...?
Maybe DOR instead of ETR? Keep RAL (or could I switch to a once a day INSTI)? And add TAF/FTC (TAF likely to have some activity)?
Hm... Thanks for any wisdom. I'm still learning.
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Elliot Goodenough
Philadelphia PA
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