Î IDSA suggests using ACE inhibitors or ARBs to treat proteinuric
nephropathy in children with HIV infection and suggests their use as
first-line therapy for hypertension in these children. Because HIV-
infected children with proteinuria may be at greater risk for salt wasting
and prone to dehydration, ACE inhibitors and ARBs should be used with
caution in children (W-VL).
Î IDSA suggests that corticosteroids NOT be used in children with HIVAN
(W-VL).
Table 4. Dosing of Antiretroviral Drugs for HIV-Infected
Adults With CKD or ESRD
Antiretroviral
Drug and Dosing
Category Dosage Comments
Nucleoside reverse transcriptase inhibitors (NRTIs)
Zidovudine
CrCl ≥15 mL/min 300 mg PO bid
CrCl <15 mL/min,
HD, or peritoneal
dialysis (PD)
100 mg PO q6-8h or 300 mg
daily
Based on longer
intracellular half-life
Lamivudine
CrCl ≥50 mL/min 150 mg PO bid/300 mg PO daily
CrCl 30-49 mL/min 150 mg PO daily
CrCl 15-29 mL/min 150 mg PO first dose, then
100 mg PO daily
CrCl 5-14 mL/min 150 mg PO first dose, then 50 mg
PO daily
To avoid using the liquid
formulation and because
of the favorable safety
profile, some recommend
using the lowest available
tablet dose of 100 mg
(lamivudine hepatitis B
formulation) or 150 mg
(lamivudine) daily in
advanced renal disease.
CrCl <5 mL/min,
HD, or PD
50 mg PO first dose, then 25 mg
PO daily
Abacavir
All CrCl 300 mg PO bid/600 mg PO daily
Receiving HD No adjustment
a
Receiving PD Unknown, use with caution
Treatment
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