Material Educativo

[Artigo] Lopinavir; Ritonavir (All Populations Monograph)

Indications/Dosage
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Labeled

  • human immunodeficiency virus (HIV) infection

Off-Label, Recommended

  • coronavirus disease 2019 (COVID-19) †
  • human immunodeficiency virus (HIV) prophylaxis †
  • severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection †

† Off-label indication

NOTE: HIV guidelines recommend consideration be given to avoiding use of lopinavir; ritonavir-containing regimens in patients at high risk for cardiovascular adverse events.[46638]

Initiation of therapy for HIV treatment: [46638] [23512] [42452]

  • For adults, initiation of treatment immediately (or as soon as possible) after HIV diagnosis is recommended in all patients to
    reduce the risk of disease progression and to prevent the transmission of HIV, including perinatal transmission and
    transmission to sexual partners. Starting antiretroviral therapy early is particularly important for patients with AIDS-defining
    conditions, those with acute or recent HIV infection, and individuals who are pregnant; delaying therapy in these
    subpopulations has been associated with high risks of morbidity, mortality, and HIV transmission.
  • Antiretroviral drug-resistance testing:
  1. Genotypic drug-resistance testing is recommended prior to initiation of therapy in all antiretroviral treatmentnaive patients and prior to changing therapy for treatment failure.
  2. Phenotypic resistance testing may be used in conjunction with the genotypic test for patients with known or
    suspected complex drug-resistance mutation patterns.
  3. HIV-1 proviral DNA resistance testing is available for use in patients with HIV RNA concentrations below the
    limits of detection or with low-level viremia (i.e., less than 1,000 copies/mL), where genotypic testing is unlikely
    to be successful; however, the clinical utility of this assay has not been fully determined.
  • Pediatric guidelines are also available.

Place in therapy for HIV treatment: [46638] [23512] [42452]

  • Lopinavir; ritonavir (twice daily) given in combination with 2 NRTIs is an alternative protease inhibitor-based treatment
    regimen for pregnant adults and adolescents with HIV-1, HIV-2, or HIV-1/HIV-2 coinfection. Once-daily lopinavir; ritonavir is NOT recommended for use during pregnancy.
  • Due to a high pill burden and low tolerability, use of this drug as part of an initial HIV-1 treatment regimen for non-pregnant, treatment-naive adults and adolescents is no longer recommended.
  • Lopinavir; ritonavir plus 2 NRTIs is also an alternative initial regimen for some non-pregnant patients who have HIV-2
    monoinfection or HIV-1/HIV-2 coinfection.
  • Pediatric guidelines are also available.

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