Table 4. Dosing of Antiretroviral Drugs for HIV-Infected
Adults With CKD or ESRD (continued)
Antiretroviral
Drug and Dosing
Category Dosage Comments
Entry/fusion inhibitors
b
Enfuvirtide 90 mg subcutaneous bid
Integrase strand transfer inhibitors (INSTIs)
Raltegravir
b
400 mg PO bid
Elvitegravir, cobicistat, tenofovir disoproxil fumarate, emtricitabine
CrCl ≥70 mL/min 1 tablet (150 mg elvitegravir,
150 mg cobicistat, 200 mg emtricitabine,
300 mg tenofovir disoproxil fumarate)
PO daily with food
CrCl <50 mL/min Discontinue
Dolutegravir
CrCl >30 mL/min
• 50 mg once daily (ARV- or INSTI-
naive patients)
• 50 mg bid (INSTI-experienced with
certain INSTI mutations)
CrCl <30 mL/min Use with close monitoring Dolutegravir
concentrations
decreased by
40%. Clinical
significance
unknown,
but INSTI-
experienced
patients with
INSTI mutations
may be at increased
risk for virologic
breakthrough.
CCR5 antagonist
Maraviroc
CrCl >30 mL/min 300 mg PO bid (adjustment needed with
most PI and NNRTI coadministration)
CrCl <30 mL/min 300 mg PO bid. Reduce dose to 150 mg
PO bid if orthostatic hypotension occurs.
Avoid maraviroc with CYP3A4 inhibitor
(eg, macrolides, PIs)
a
Administer dose aer HD on days when HD performed.
b
No dose adjustment needed with CKD or ESRD.
Treatment
12
