When should TDF be switched to TAF in HIV?

Tenofovir alafenamide (TAF) preferred over TDF when CrCl 3 mL/min/year; TAF has equivalent efficacy with 91% lower plasma tenofovir and less renal/bone toxicity.

Which ART drugs are contraindicated in severe hepatic impairment?

Atazanavir and tipranavir: avoid in Child-Pugh C; ritonavir: avoid in hepatic decompensation; nevirapine: contraindicated if ALT >5x ULN; integrase inhibitors (dolutegravir, raltegravir) are safest in hepatic impairment; TAF is hepatically activated but generally safe in moderate impairment.

What CYP3A4 drug interactions are critical with ritonavir-boosted ART?

Ritonavir is a potent CYP3A4 inhibitor (used as pharmacokinetic booster); increases: statins (myopathy - rosuvastatin preferred), sildenafil (hypotension), midazolam (prolonged sedation), rifampicin (reduces PI levels 75% - avoid); contraceptive hormones may be ineffective.

What is the integrase inhibitor advantage for drug-naive HIV patients?

DTG (dolutegravir) + TAF/FTC has highest potency, high barrier to resistance, excellent tolerability, few drug interactions; recommended first-line in DHHS/EACS guidelines; ADVANCE trial: DTG-based regimen superior to efavirenz in Africa; safe in pregnancy from conception.

How is antiretroviral PrEP dosed for HIV prevention?

Daily oral PrEP: TAF/FTC (Descovy) or TDF/FTC (Truvada) daily; event-driven (2-1-1): TDF/FTC 2 tablets 24-48h before sex, 1 tablet 24h and 48h after; injectable cabotegravir 600 mg IM every 2 months (superior to daily oral PrEP in HPTN 083/084).

Antiretroviral Therapy Renal/Hepatic Dose Adjustment Calculator

Adjusts antiretroviral dosing for renal impairment (tenofovir alafenamide vs TDF), hepatic impairment (atazanavir/darunavir modification), and drug interaction screening for CYP3A4/P-glycoprotein interactions.

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Frequently Asked Questions

When should TDF be switched to TAF in HIV?

Which ART drugs are contraindicated in severe hepatic impairment?

What CYP3A4 drug interactions are critical with ritonavir-boosted ART?

What is the integrase inhibitor advantage for drug-naive HIV patients?

How is antiretroviral PrEP dosed for HIV prevention?