•
Do not substitute EFV for nevirapine after G4 toxicity but when there are no alternatives to substituting NVP it may be possible to use EFV cautiously5. Triple NRTI may be used.
Table 15: Laboratory Grading of Adverse Events in Adults and adolescents (ACTG) Laboratory Test Abnormalities ITEM
GRADE 1 TOXICITY Haemoglobin 8.0-9.4 g/dL Absolute Neutrophil 1,000-1,500 mm3 Count Platelets -75,0000- 99,000 ALT Bilirubin Amylase/lipase Triglycerides * Cholesterol * MANAGEMENT
5
GRADE 2 TOXICITY 7.0-7.9 g/dL 750-990 mm3
GRADE 3 TOXICITY 6.5-6.9 g/dL 500-749 mm3
50,000-74,999
20,0000-49,999 mm3 1.25-2.5 X upper 2.5-5 X upper 5.0-10 X upper normal limit normal limit normal limit 1-1.5XULN 1.5-2.5 X ULN 2.5-5 x upper limits of normal 1-1.5XULN 1.5-2 X ULN 2-5 x upper limits of normal 200-399mg/dL 400-750 mg/dL 751-1200mg/dL 1.0 –1.3 X Upper 1.3-1.6 X Upper 1.6-2.0 X Upper normal limit normal limit normal limit Continue ARV substitute Repeat test 2 weeks after initial test and responsible drug reassess Lipid imbalances could be managed with diet, exercise and pharmacologically with the use of fibrates. ALWAYS SEEK EXPERT ADVICE IN CASE OF DOUBT
Continue with the NRTI back bone and substitute EFZ after 1-2 weeks.
80
GRADE 4 TOXICITY <6.5 g/dL <500 mm3 <20,000 10 X upper normal limit >5 x upper limits of normal >5x upper limits of normal >1200mg/dL 2.0 X Upper normal limit Stop ARV and consult experience physician