A Management Tool for H V "03%̞"03%Ô',2#0 !2'-,1

A MANAGEMENT TOOL FOR H V "03%̞"03%ô',2#0 !2'-,1

The Canadian HIV/AIDS Pharmacists Network (CHAP) INTRODUCTION CU@MBDRÓHMÓ@MSHQDSQNUHQ@KÓSGDQ@OXÓG@UDÓSTQMDCÓ'(5ÓHMSNÓ@ÓBGQNMHB ÓL@M@FD@AKDÓCHRD@RD Ó/@SHDMSRÓNȓDMÓQDPTHQDÓSQD@SLDMSÓENQÓBN LNQAHCÓBNMCHSHNMRÓ@RÓVDKKÓ@RÓ'(5 Ó@MCÓBNMRDPTDMSKX Ó OG@QL@BNJHMDSHBÓHMSDQ@BSHNMRÓADSVDDMÓ@MSHQDSQNUHQ@KRÓ 15RÓ@MCÓNSGDQÓCQTFÓBK@RRDRÓ@QDÓ@MÓHMBQD@RHMFÓBNMBDQM ÓÓ3GHRÓSNNKÓG@RÓADDMÓBQD@SDCÓ@RÓ@ÓPTHBJÓQDEDQDMBDÓSNÓ@RRHRSÓBKHMHBH@MRÓHMÓSGDÓ BKHMHB@KÓL@M@FDLDMSÓNEÓSGDRDÓHMSDQ@BSHNMRÓ@MCÓHRÓHMSDMCDCÓENQÓTRDÓAXÓ@MCÓVHSGÓDWODQHDMBDCÓOGXRHBH@MR ÓMTQRDRÓ@MCÓOG@QL@BHRSR ÓÓ Disclaimer 3GDÓHMENQL@SHNMÓVHSGHMÓHRÓMNSÓHMSDMCDCÓSNÓQDOK@BDÓRNTMCÓOQNEDRRHNM@KÓITCFLDMSÓHMÓHMCHUHCT@KÓRHST@SHNMR Ó@MCÓRGNTKCÓADÓTRDCÓHMÓBNMITMBSHNMÓVHSGÓNSGDQÓQDKH@AKDÓRNTQBDRÓNEÓHMENQL@SHNM Ó#TDÓSNÓ SGDÓQ@OHCKXÓBG@MFHMFÓM@STQDÓNEÓHMENQL@SHNMÓ@ANTSÓ'(5ÓSQD@SLDMSÓ@MCÓSGDQ@OHDR ÓTRDQRÓ@QDÓ@CUHRDCÓSNÓQDBGDBJÓSGDÓHMENQL@SHNMÓBNMS@HMDCÓGDQDHMÓVHSGÓSGDÓNQHFHM@KÓRNTQBDÓADENQDÓ@OOKXHMFÓHSÓSNÓ O@SHDMSÓB@QD ÓÓ#DBHRHNMRÓ@ANTSÓO@QSHBTK@QÓLDCHB@KÓSQD@SLDMSRÓRGNTKCÓ@KV@XRÓADÓL@CDÓHMÓBNMRTKS@SHNMÓVHSGÓ@ÓPT@KHȏDCÓLDCHB@KÓOQ@BSHSHNMDQÓJMNVKDCFD@AKDÓ@ANTSÓ'(5 QDK@SDCÓHKKMDRRÓ@MCÓSGDÓ SQD@SLDMSRÓHMÓPTDRSHNM ÓÓ -DHSGDQÓ"' / Ó3NQNMSNÓ&DMDQ@KÓ'NROHS@K Ó2S Ó,HBG@DKRÓ'NROHS@K Ó4MHUDQRHSXÓNEÓ3NQNMSN Ó6HMCRNQÓ1DFHNM@KÓ'NROHS@K Ó1DFHM@Ó&DMDQ@KÓ'NROHS@K Ó"DMSQDÓ'NROHS@KHDQÓCDÓK4MHUDQRHS~ÓCDÓ,NMSQ~@KÓ ÓMNQÓ SGDÓ@TSGNQRÓ@QDÓQDRONMRHAKDÓENQÓCDKDSHNMRÓNQÓHM@BBTQ@BHDRÓHMÓHMENQL@SHNMÓNQÓENQÓBK@HLRÓNEÓHMITQXÓQDRTKSHMFÓEQNLÓ@MXÓRTBGÓCDKDSHNMRÓNQÓHM@BBTQ@BHDR ÓÓ,DMSHNMÓNEÓRODBHȏBÓCQTFR ÓCQTFÓCNRDRÓNQÓ CQTFÓBNLAHM@SHNMRÓVHSGHMÓSGHRÓSNNKÓCNDRÓMNSÓBNMRSHSTSDÓDMCNQRDLDMSÓAXÓ"' / ÓSGDÓ@TSGNQRÓNQÓSGDHQÓ@ȑKH@SDCÓHMRSHSTSHNMR Acknowledgements: 3GDÓCDUDKNOLDMSÓSD@LÓNMÓADG@KEÓNEÓSGDÓ"@M@CH@MÓ'(5 (#2Ó/G@QL@BHRSRÓ-DSVNQJÓ"' /ÓHMBKTCDR gÓÓ+HMC@Ó1NAHMRNM Ó!2B /GL Ó '(5$ Ó6HMCRNQÓ1DFHNM@KÓ'NROHS@K gÓÓ,HBG@DKÓ2STADQ Ó!2/ Ó1DFHM@Ó&DMDQ@KÓ'NROHS@K gÓÓ1@BGDKÓ3GDQQHDM Ó! /GL Ó, 2B Ó"DMSQDÓ'NROHS@KHDQÓCDÓK4MHUDQRHS~ÓCDÓ,NMSQ~@KÓÓ"'4, gÓÓ KHBDÓ3RDMF Ó/G@QL # Ó%"2'/ Ó '(5/ Ó3NQNMSNÓ&DMDQ@KÓ'NROHS@KÓ @MCÓ&NQCNMÓ QADRR Ó,# Ó""%/ Ó#DO@QSLDMSÓNEÓ"NLLTMHSXÓÓ%@LHKXÓ,DCHBHMD Ó2S Ó,HBG@DKRÓ'NROHS@K Ó%@BTKSXÓNEÓ,DCHBHMD Ó4MHUDQRHSXÓNEÓ3NQNMSN /QHMSÓOQNCTBSHNMÓNEÓSGHRÓSNNKÓV@RÓL@CDÓONRRHAKDÓSGQNTFGÓ@MÓTMQDRSQHBSDCÓDCTB@SHNM@KÓFQ@MSÓEQNLÓ,DQBJÓ"@M@C@ H V ! 0"'-4 1!3* 0ô"03%1ô ,2'&7.#02#,1'4#1ô ,"ô"'%-6',

! *!'3+ô!& ,,#*ô ACEI ARBs #2 ̝ *-!)#01 "'30#2'!1 DIGOXIN *-!)#01ơ̂!! ̜ Acebutolol, $OQNR@QS@M Ó bisoprolol, %TQNRDLHCD Ó !DM@YDOQHK ÓDM@K@OQHK Ó Candesartan, LKNCHOHMD ÓCHKSH@YDL Ó olmesartan, Atenolol, labetalol, GXCQNBGKNQN lisinopril, perindopril, irbesartan, EDKNCHOHMD ÓMHEDCHOHMD Ó Indapamide telmisartan, nadolol metoprolol, SGH@YHCD Ó ramipril, etc. losartan verapamil valsartan pindolol, spironolactone propranolol ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖȖȖȖȖȖȖȖ η η η η η Potential /NSDMSH@KÓENQÓ Ó""! ÓÓÓ /NSDMSH@KÓENQÓ • #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? ȖȖ /NSDMSH@KÓENQÓ Ȗ ENQÓ Consider 50% dose Ȗ /NSDMSH@KÓENQÓ ÓÓ Ó 1! ADS@ NQÓRS@QSÓVHSGÓKNVDRSÓ indapamide CHFNWHM blocker dose possible • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01

0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ôC E η η η η η • 2 8 , 4'0 (Evotaz, Reyataz) Potential Potential ȖȖ /NSDMSH@KÓENQÓ Ȗ ENQÓ /NSDMSH@KÓENQÓ Ó""! ÓÓÓ Ȗ /NSDMSH@KÓENQÓ • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô ÓÓ Ó 1! ENQÓ CHFNWHM ADS@ Consider 50% dose indapamide • *-.', 4'0 (Kaletra) blocker ! 0"'-4 1!3* 0

• #$ 4'0#,8ô1SQRGT? ô RPGNJ? η η η /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ • #20 4'0',#ô'LRCJCLAC ȖȖ ȖȖ /NSDMSH@KÓENQÓ Ó""! Ȗ Ȗô ÓÓ Ó 1! • ,#4'0 .',#ô(Viramune) indapamide

,-2#1 ! 0"'-4 1!3* 0

! 0"'-4 1!3* 0ô"03%1ô ,2'&7.#02#,1'4#1ô ,"ô"'%-6', +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

! *!'3+ô!& ,,#*ô ACEI ARBs #2 ̝ *-!)#01 *-!)#01ơ̂!! ̜ "'30#2'!1 DIGOXIN Conversion via 2C9 to ,HWDCÓ"8/ÓRTARSQ@SDRÓ active metabolite @BDATSNKNK ÓAHRNOQNKNK Ó (MGHAHSHNMÓNEÓ (MCTBSHNMÓNEÓ ,HWDCÓ"8/ÓRTARSQ@SDRÓ 1DM@KKXÓBKD@QDC KNR@QS@M Ó2TARSQ@SDÓNEÓ (MGHAHSHNMÓNEÓ/ FKXBNOQNSDHM +#!& ,'1+ô-$ô',2#0 !2'-, labetalol, metoprolol, "8/ "8/ HMC@O@LHCD "ÓB@MCDR@QS@M Ó OHMCNKNK ÓOQNOQ@MNKNK HQADR@QS@M 1HSNM@UHQÓ@MCÓ BNAHBHRS@S 1HSNM@UHQÓ@MCÓBNAHBHRS@S $KUHSDFQ@UHQÓHMCTBSHNM Ó 1HSNM@UHQÓ@MCÓBNAHBHRS@S 1HSNM@UHQÓ@MCÓBNAHBHRS@S -NÓRHFMHȏB@MSÓHMSDQ@BSHNMRÓ boosted boosted protease DE@UHQDY ÓDSQ@UHQHMDÓ boosted protease ,NRSÓ--13(R boosted protease inhibitors + ',ô',2#0 !2',%ô 04s predicted protease inhibitors and elvitegravir HMGHAHSHNM inhibitors and elvitegravir and elvitegravir inhibitors and @MCÓLNRSÓ--13(R elvitegravir CITRSÓB@MCDR@QS@M Ó CITRSÓADS@ AKNBJDQÓCNRDÓ CITRSÓ""!Ó CITRSÓHMC@O@LHCDÓCNRDÓ irbesartan, losartan dose @BBNQCHMFÓSNÓQDRONMRD Consider 50% dose @BBNQCHMFÓSNÓQDRONMRD CITRSÓCHFNWHMÓCNRDÓ @BBNQCHMFÓSNÓQDRONMRD SNWHBHSX ÓÓ.SGDQÓ dose 4RDÓRS@MC@QCÓCQTFÓCNRDR according to SNWHBHSX ÓÓ.SGDQÓCHTQDSHBRÓ @BBNQCHMFÓSNÓQDRONMRD MANAGEMENT SNWHBHSX ÓÓ.SGDQÓ 1!RÓL@XÓ ADS@ AKNBJDQRÓ@SDMNKNK Ó reduction in DȑB@BX L@XÓADÓTRDCÓVHSGNTSÓ SNWHBHSX ADÓTRDCÓVHSGNTSÓCNRDÓ M@CNKNKÓL@XÓADÓTRDCÓ ""! SNWHBHSX CNRDÓ@CITRSLDMS @CITRSLDMS VHSGNTSÓCNRDÓ@CITRSLDMS ""!ÓSNWHBHSXÓ #HFNWHMÓBNMBDMSQ@SHNMR Ó heart rate, !DS@ AKNBJDQÓSNWHBHSXÓÓ (MC@O@LHCDÓSNWHBHSXÓÓ SNWHBHSXÓ@QQGXSGLH@R Ó blood heart rate, blood CHYYHMDRR ÓGD@C@BGD Ó ventricular tachycardia, 1!ÓDȑB@BXÓ@MCÓSNWHBHSX pressure, ""!ÓDȑB@BX +-,'2-0',% OQDRRTQD ÓRGNQSMDRRÓNEÓ hyperglycemia, bradycardia, AV block, RGNQSMDRRÓNEÓ breath. hypokalemia @MNQDWH@ ÓM@TRD@ ÓAKTQQDC breath, XDKKNVÓUHRHNM ÓGD@C@BGD CHYYHMDRR ! 0"'-4 1!3* 0

! 0"'-4 1!3* 0ô"03%1ô ,2'.* 2#*#21ô ,"ô ,2'!- %3* ,21

,2'.* 2#*#21 ,2'!- %3* ,21

"+./(#.&1$+ /1 24&1$+ 3(" &1$+.1Ó # !(& 31 - 1(5 1.7 ! - /(7 ! - 6 1% 1(- 2 /K@UHW $ȑDMS !QHKHMS@ /Q@C@W@ 7@QDKSN $KHPTHR "NTL@CHM

',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖȖȖȖȖȖȖ X η X X η /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ • #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? ȖȖȖ dabigatran and /NSDMSH@KÓENQÓ ticagrelor and QHU@QNW@A@MÓ@MCÓ @OHW@A@MÓ@MCÓ V@QE@QHM SNWHBHSX SNWHBHSX SNWHBHSX SNWHBHSX • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 η 1HSNM@UHQ ANNRSDCÓ/(RÓÓ 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ôC E X η X X ONSDMSH@KÓENQÓÓ • 2 8 , 4'0 (Evotaz, Reyataz) ȖȖȖ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ V@QE@QHM • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô ticagrelor and dabigatran and QHU@QNW@A@MÓ@MCÓ @OHW@A@MÓ@MCÓ "NAHBHRS@S • *-.', 4'0 (Kaletra) SNWHBHSX SNWHBHSX SNWHBHSX SNWHBHSX ANNRSDCÓ/(RÓÓ ONSDMSH@KÓENQÓ V@QE@QHMÓ concentrations ! 0"'-4 1!3* 0

,2'.* 2#*#21 ,2'!- %3* ,21

"+./(#.&1$+ /1 24&1$+ 3(" &1$+.1 # !(& 31 - 1(5 1.7 ! - /(7 ! - 6 1% 1(- 2 /K@UHW $ȑDMS !QHKHMS@ /Q@C@W@ 7@QDKSN $KHPTHR "NTL@CHM

,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 • 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR ȖȖȖȖȖȖȖȖ Ȗô η $E@UHQDMY Ó $E@UHQDMY Ó nevirapine DSQ@UHQHMDÓÓ • #$ 4'0#,8ô1SQRGT? ô RPGNJ? ONSDMSH@KÓENQÓ X X X V@QE@QHMÓ • #20 4'0',#ô'LRCJCLAC Ȗ η Ȗ Ȗ $SQ@UHQHMDÓÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ concentrations • ,#4'0 .',#ô(Viramune) /NSDMSH@KÓENQÓ ticagrelor QHU@QNW@A@MÓ @OHW@A@MÓÓ -DUHQ@OHMDÓÓ active ONSDMSH@KÓENQÓ LDS@ANKHSDÓNEÓ V@QE@QHMÓ clopidogrel concentrations ,3!*#-2'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 η /NSDMSH@KÓENQÓ • 2#,-$-4'0ô"'1-.0-6'* (Viread, Truvada, QDM@KÓSNWHBHSXÓ RPGNJ? ô!MKNJCP? ô1RPG@GJB VHSGÓGHFGÓCNRDÓ ȖȖȖȖȖȖȖ or prolonged 2 ÓTRD ! 0"'-4 1!3* 0

! 0"'-4 1!3* 0ô"03%1ô ,2'.* 2#*#21ô ,"ô ,2'!- %3* ,21 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

,2'.* 2#*#21 ,-4#*ô-0 *ô ,2'!- %3* ,21ơ̂,- !1̜ WARFARIN

(MGHAHSHNMÓNEÓ (MCTBSHNMÓNEÓ (MGHAHSHNMÓNEÓ (MCTBSHNMÓNEÓ Combining (MGHAHSHNMÓNEÓ"Ó "8/ Ó/ FOÓ "8/ Ó/ FOÓ (MGHAHSHNMÓNEÓ/ FOÓ "8/ Ó/ FOÓ "8/ Ó/ FOÓ MDOGQNSNWHBÓ@FDMSRÓ (MCTBSHNMÓNEÓ"8/" (MGHAHSHNMÓNEÓ"8/" +#!& ,'1+ô-$ô',2#0 !2'-, BKNOHCNFQDK QHU@QNW@A@M Ó QHU@QNW@A@M Ó C@AHF@SQ@M SHB@FQDKNQ SHB@FQDKNQ 2 @OHW@A@M @OHW@A@M 1HSNM@UHQÓANNRSDCÓ 1HSNM@UHQÓ@MCÓ ,NRSÓ--13(RÓ 1HSNM@UHQÓ@MCÓ ,NRSÓ--13(RÓ 1HSNM@UHQÓ@MCÓ 3DMNENUHQÓCHRNOQNWHKÓ regimens, BNAHBHRS@S ANNRSDCÓ DE@UHQDMY Ó BNAHBHRS@S ANNRSDCÓ DE@UHQDMY Ó BNAHBHRS@S ANNRSDCÓ $SQ@UHQHMD 3#%ÓBNMS@HMHMFÓ nevirapine, $E@UHQDMY ÓDSQ@UHQHMD + ',ô',2#0 !2',%ô 04s protease inhibitors etravirine, protease inhibitors etravirine, protease inhibitors regimens DKUHSDFQ@UHQ and elvitegravir MDUHQ@OHMD and elvitegravir MDUHQ@OHMD and elvitegravir cobicistat #@AHF@SQ@MÓ UNHCÓGHFG CNRDÓNQÓ monograph advises 4RDÓVHSGÓB@TSHNM ÓÓ OQNKNMFDCÓ 2 ÓTRDÓ B@TSHNMÓVHSGÓ/ FOÓ Avoid ,@XÓVHRGÓSNÓ HEÓONRRHAKD ÓÓ inhibitors. (MBQD@RDÓV@QE@QHMÓ #DBQD@RDÓV@QE@QHMÓ Contraindicated. OHW@A@MÓ@MCÓ Avoid use. Consider coadministration. consider Consider alternate Preliminary dose as needed to dose as needed to Prasugrel may be QHU@QNW@A@MÓ@QDÓ alternative such as MANAGEMENT Prasugrel may be alternatives to HIV agent, such as pharmacokinetic maintain maintain used contraindicated V@QE@QHM used clopidogrel, such as abacavir or data suggest that a SGDQ@ODTSHBÓ(-1 SGDQ@ODTSHBÓ(-1 prasugrel. SDMNENUHQÓ BKHMHB@KKXÓRHFMHȏB@MSÓ @K@EDM@LHCDÓ3 % interaction may not occur

3HB@FQDKNQÓSNWHBHSXÓÓ ,NMHSNQÓQDM@KÓ 6@QE@QHMÓSNWHBHSXÓÓ dyspnea, headache, AKDDCHMF ÓCHYYHMDRR Ó ETMBSHNM Anticoagulant Anticoagulant Anticoagulant DOHRS@WHR ÓBGDRSÓ 3HB@FQDKNQÓDȑB@BX Antiplatelet activity headache, +-,'2-0',% SNWHBHSX SNWHBHSX DȑB@BX pain, bleeding RRDRRÓ.3"Ó RGNQSMDRRÓNEÓAQD@SG Ó events -2 (#ÓTRD hypotension ! 0"'-4 1!3* 0

! 0"'-4 1!3* 0ô"03%1ô 12 2',1

2-04 12 2', 0-134 12 2',ô .'2 4 12 2',ô .0 4 12 2', *-4 12 2',ôô 1'+4 12 2',ôô *GNGRMP !PCQRMP *GT?JM .P?T?AFMJ +CT?AMP 8MAMP ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖȖȖȖȖ

• #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? η ȖȖ η X /NSDMSH@KÓENQÓ statin /NSDMSH@KÓENQÓ statin /NSDMSH@KÓENQÓ ÓRS@SHMÓ@MCÓSNWHBHSX • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 η η 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ôC E /NSDMSH@KÓENQÓ statin. /NSDMSH@KÓENQÓ statin. • 2 8 , 4'0 (Evotaz, Reyataz) 4RDÓKNVDRSÓRS@SHMÓCNRDÓ 4RDÓKNVDRSÓRS@SHMÓCNRDÓ Ȗ η X • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô possible L@WHLTLÓ possible L@WHLTLÓ /NSDMSH@KÓENQÓ statin /NSDMSH@KÓENQÓ ÓRS@SHMÓ@MCÓSNWHBHSX • *-.', 4'0 (Kaletra) 20 mg atorvastatin ÓLFÓQNRTU@RS@SHMÓ C@HKX C@HKX ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 • 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR ȖȖȖȖȖȖ • #$ 4'0#,8ô1SQRGT? ô RPGNJ? • #20 4'0',#ô'LRCJCLAC η η η /NSDMSH@KÓENQÓ statin ȖȖȖ /NSDMSH@KÓENQÓ statin /NSDMSH@KÓENQÓ statin • ,#4'0 .',#ô(Viramune) ! 0"'-4 1!3* 0

! 0"'-4 1!3* 0ô"03%1ô 12 2',1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

2-04 12 2', ô.0 4 12 2', ô &+%̝!- ô0#"3!2 1#ô',&' '2-01ô1R?RGLQ *-4 12 2', ô1'+4 12 2', .'2 4 12 2', 0-134 12 2',

+#!& ,'1+ô-$ô',2#0 !2'-, (MGHAHSHNMÓNEÓ"8/ (MGHAHSHNMÓNEÓ"8/ Ó. 3/! Ó!"1/ /QHL@QHKXÓBKD@QDCÓUH@Ó4&3 Ó. 3/!

1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓOQNSD@RDÓHMGHAHSNQRÓ 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓOQNSD@RDÓHMGHAHSNQRÓ + ',ô',2#0 !2',%ô 04s and elvitegravir and elvitegravir None

MANAGEMENT "NMSQ@HMCHB@SDC Ó4RDÓ@KSDQM@SDÓRS@SHM 4RDÓKNVDRSÓRS@SHMÓCNRDÓONRRHAKDÓ@MCÓSHSQ@SDÓSNÓDȎDBS ,NRSÓ 15RÓL@XÓADÓTRDC

+-,'2-0',% 2S@SHMÓSNWHBHSXÓLX@KFH@ ÓQG@ACNLXNKXRHR 2S@SHMÓSNWHBHSXÓLX@KFH@ ÓQG@ACNLXNKXRHR 2S@SHMÓSNWHBHSXÓLX@KFH@ ÓQG@ACNLXNKXRHR

,-2#1

Ȗ No dose adjustment required. η Use combination with caution. Adjustment in drug dose or frequency, additional/more frequent monitoring, or use Contraindicated/avoid combination. of an alternative agent may be required. May wish to consult with a pharmacist knowledgeable in HIV drug interactions. X %#,'2-30', 07

%#,'2-30', 07ô"03%1ô 20# 2+#,2ô$-0ô #,'%,ô.0-12 2'!ô&7.#0.* 1' ơ̂ .&̜ô-0ô*-5#0ô30', 07ô20 !2ô17+.2-+1ơ̂*321̜

ô *.& ô0#"3!2 1#ô *.& ôô "0#,#0%'!ô0#!#.2-0ô *.& ôô "0#,#0%'!ô0#!#.2-0ô *-!)#01ô PDE5 ',&' '2-01 *-!)#01ôLML QCJCARGTC QCJCARGTC ',&' '2-01 3 # + %(+Ó #43 23$1(#$ %(- 23$1(#$Ó #.7 9.2(-Ó 3$1 9.2(-Ó +%49.2(-Ó 2(+.#.2(-Ó 3 ,24+.2(- "H@KHRÓ UNC@QS /QNRB@Q "@QCTQ@ 'XSQHMÓ 7@SQ@K 1@O@ȐN %KNL@WÓ"1 5 mg daily dose .-+8 * ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖȖȖȖȖȖȖ η η /NSDMSH@KÓENQÓ X /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ S@C@K@ȏKÓATSÓ η η η /NSDMSH@KÓENQÓ silodosin. tamsulosin. CNRDÓ@CITRSLDMSÓ • #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ Ȗ @KETYNRHMÓ 4RDÓÓLFÓCNRDÓ 4RDÓ ÓLFÓCNRDÓ MNSÓQDPTHQDCÓ dutasteride CNW@YNRHM SDQ@YNRHM concentrations and monitor and monitor ENQÓÓLFÓC@HKXÓ @MCÓSNWHBHSX ENQÓSNWHBHSX ENQÓSNWHBHSX CNRDÓNMKX • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 η η /NSDMSH@KÓENQÓ 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ôC E X /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ S@C@K@ȏKÓATSÓ • 2 8 , 4'0 (Evotaz, Reyataz) η η η /NSDMSH@KÓENQÓ silodosin. tamsulosin. CNRDÓ@CITRSLDMSÓ /NSDMSH@KÓENQÓ Ȗ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô @KETYNRHMÓ 4RDÓÓLFÓCNRDÓ 4RDÓ ÓLFÓCNRDÓ MNSÓQDPTHQDCÓ dutasteride CNW@YNRHM SDQ@YNRHM concentrations • *-.', 4'0 (Kaletra) and monitor and monitor ENQÓÓLFÓC@HKXÓ @MCÓSNWHBHSX ENQÓSNWHBHSX ENQÓSNWHBHSX CNRDÓNMKX %#,'2-30', 07

ô *.& ô0#"3!2 1#ô *.& ôô "0#,#0%'!ô0#!#.2-0ô *.& ôô "0#,#0%'!ô0#!#.2-0ô *-!)#01ô PDE5 ',&' '2-01 *-!)#01ôLML QCJCARGTC QCôJCARGTC ',&' '2-01 3 # + %(+Ó #43 23$1(#$ %(- 23$1(#$Ó #.7 9.2(-Ó 3$1 9.2(-Ó +%49.2(-Ó 2(+.#.2(-Ó 3 ,24+.2(- "H@KHRÓ UNC@QS /QNRB@Q "@QCTQ@ 'XSQHMÓ 7@SQ@K 1@O@ȐN %KNL@WÓ"1 5 mg daily dose only* ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01

• 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR ȖȖȖȖȖȖȖȖ

• #$ 4'0#,8ô1SQRGT? ô RPGNJ? η η η η /NSDMSH@KÓENQÓ • #20 4'0',#ô'LRCJCLAC /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ η Ȗ /NSDMSH@KÓENQÓ drug concentrations drug dutasteride CNW@YNRHM SDQ@YNRHM • ,#4'0 .',#ô(Viramune) concentrations

* NB: For tadalafil, this table refers to the daily dose of 5 mg for benign prostatic hyperplasia. Please refer to “Genitourinary Drugs: PDE5 Inhibitors for Erectile Dysfunction (ED) or Pulmonary Arterial Hypertension (PAH)” table for recommendations on higher or intermittent dosing of tadalafil with antiretrovirals.

,-2#1 %#,'2-30', 07

%#,'2-30', 07ô"03%1ô 20# 2+#,2ô$-0ô #,'%,ô.0-12 2'!ô&7.#0.* 1' ơ̂ .&̜ô-0ô*-5#0ô30', 07ô20 !2ô17+.2-+1ơ̂*321̜ +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

."#ô',&' '2-0 *.& ôô "0#,#0%'!ô *-!)#01 *.& ôô "0#,#0%'!ô *-!)#01ô ô *.& ô0#"3!2 1#ô',&' '2-01 2 " * $'*ô LML QCJCARGTC QCJCARGTC ôKEôB?GJWôBMQCô-,*7 (MGHAHSHNMÓNEÓ"8/ Ó (MGHAHSHNMÓNEÓ"8/ Ó (MCTBSHNMÓNEÓ"8/ Ó (MGHAHSHNMÓNEÓ"8/ Ó (MCTBSHNMÓNEÓ"8/ Ó (MGHAHSHNMÓNEÓ"8/ Ó @KETYNRHM ÓRHKNCNRHM Ó (MCTBSHNMÓNEÓ"8/ Ó@KK +#!& ,'1+ô-$ô',2#0 !2'-, CTS@RSDQHCD CTS@RSDQHCD CNW@YNRHM ÓSDQ@YNRHM CNW@YNRHM ÓSDQ@YNRHM S@C@K@ȏK S@LRTKNRHM ,@XÓADÓTRDCÓVHSGÓ@KKÓ 15R /KD@RDÓQDEDQÓSNÓ a%CLGRMSPGL?PWô"PSEQôô ."#ô'LFG@GRMPQôDMPô 1HSNM@UHQÓ@MCÓBNAHBHRS@S 1HSNM@UHQÓ@MCÓBNAHBHRS@S 1HSNM@UHQÓ@MCÓBNAHBHRS@S #PCARGJCô"WQDSLARGMLô + ',ô',2#0 !2',%ô 04s boosted protease ,NRSÓ--13(R boosted protease ,NRSÓ--13(R boosted protease ,NRSÓ--13(R #"ôMPô.SJKML?PWô inhibitors and elvitegravir inhibitors and elvitegravir inhibitors and elvitegravir PRCPG?Jô&WNCPRCLQGMLô . &g ÓS@AKDÓENQÓ recommendations on higher or intermittent CNRHMFÓNEÓS@C@K@ȏKÓVHSGÓ antiretrovirals #@HKXÓS@C@K@ȏKÓÓLFÓL@XÓ ADÓTRDCÓVHSGNTSÓCNRDÓ %HM@RSDQHCDÓ %HM@RSDQHCDÓ KETYNRHMÓBNMRHCDQÓKNV CNRDÓRHKNCNRHMÓNQÓS@LRTKNRHMÓ CITRSÓCNRDÓ@BBNQCHMFÓSNÓDȑB@BXSNWHBHSX @CITRSLDMS ÓÓ,@XÓ ˮ to MANAGEMENT may be used may be used VHSGÓLNMHSNQHMFÓNQÓBG@MFDÓ@MSHQDSQNUHQ@KÓQDFHLDM 2.5 mg daily based on tolerability ,NMHSNQÓENQÓSNWHBHSXÓÓ #TS@RSDQHCDÓSNWHBHSXÓÓ 3NWHBHSXÓGXONSDMRHNM Ó 3NWHBHSXÓGXONSDMRHNM Ó #NW@YNRHMÓÓSDQ@YNRHMÓ KETYNRHM ÓRHKNCNRHM Ó headache, dyspepsia, DQDBSHKDÓCXRETMBSHNM Ó #TS@RSDQHCDÓDȑB@BX CHYYHMDRR ÓGD@C@BGD Ó CHYYHMDRR ÓGD@C@BGD Ó +-,'2-0',% DȑB@BX S@LRTKNRHMÓDȑB@BX ȐTRGHMF ÓA@BJÓO@HM ÓM@R@KÓ decreased libido asthenia, nasal congestion diarrhea, nasal congestion congestion %#,'2-30', 07

%#,'2-30', 07ô"03%1ô ."#ô',&' '2-01ô$-0ô#0#!2'*#ô"71$3,!2'-,ơ̂#"̜ô-0ô.3*+-, 07ô 02#0' *ô&7.#02#,1'-,ơ̂. &̜

20# 2+#,2ô-$ô.3*+-, 07ô 02#0' *ô&7.#02#,1'-,ô 20# 2+#,2ô-$ô#0#!2'*#ô"71$3,!2'-, ̛. &̜

2(+#$- %(+Ó 3 # + %(+Ó 5 1#$- %(+Ó 2(+#$- %(+Ó 3 # + %(+Ó 5H@FQ@ "H@KHR +DUHSQ@ 1DU@SHN CBHQB@

',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖȖȖȖ η η /NSDMSH@KÓENQÓ ÓRHKCDM@ȏK ÓÓ /NSDMSH@KÓENQÓ ÓS@C@K@ȏK ÓÓ X X /NSDMSH@KÓENQÓ ÓS@C@K@ȏK ÓÓ • #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? #DBQD@RDÓRHKCDM@ȏKÓCNRDÓSNÓ #DBQD@RDÓS@C@K@ȏKÓCNRDÓ /NSDMSH@KÓENQÓ ÓU@QCDM@ȏKÓ /NSDMSH@KÓENQÓ ÓRHKCDM@ȏK 2S@QSÓ@SÓS@C@K@ȏKÓÓLFÓ ÓLFÓDUDQXÓÓGNTQR SNÓÓLFÓDUDQXÓÓGNTQR Ó @MCÓSNWHBHSX Ó@MCÓSNWHBHSX C@HKXÓ@MCÓSHSQ@SDÓSNÓÓLFÓ L@WHLTLÓÓSHLDRÓODQÓVDDJ daily based on tolerability • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖ .0-2# 1#ô',&' '2-01

0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ôC E η η η /NSDMSH@KÓENQÓ ÓS@C@K@ȏK ÓÓ /NSDMSH@KÓENQÓ ÓS@C@K@ȏK ÓÓ • 2 8 , 4'0 (Evotaz, Reyataz) /NSDMSH@KÓENQÓ ÓRHKCDM@ȏK ÓÓ X X 2S@QSÓ@SÓS@C@K@ȏKÓÓLFÓ #DBQD@RDÓRHKCDM@ȏKÓCNRDÓSNÓ #DBQD@RDÓS@C@K@ȏKÓCNRDÓ /NSDMSH@KÓENQÓ ÓU@QCDM@ȏKÓ /NSDMSH@KÓENQÓ ÓRHKCDM@ȏK • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô C@HKXÓ@MCÓSHSQ@SDÓSNÓÓLFÓ ÓLFÓDUDQXÓÓGNTQR SNÓÓLFÓDUDQXÓÓGNTQR Ó @MCÓSNWHBHSX Ó@MCÓSNWHBHSX • *-.', 4'0 (Kaletra) L@WHLTLÓÓSHLDRÓODQÓVDDJ daily based on tolerability %#,'2-30', 07

%#,'2-30', 07ô"03%1ô ."#ô',&' '2-01ô$-0ô#0#!2'*#ô"71$3,!2'-,ơ̂#"̜ô-0ô.3*+-, 07ô 02#0' *ô&7.#02#,1'-,ơ̂. &̜

20# 2+#,2ô-$ô.3*+-, 07ô 02#0' *ô&7.#02#,1'-,ô 20# 2+#,2ô-$ô#0#!2'*#ô"71$3,!2'-, ̛. &̜

2(+#$- %(+Ó 3 # + %(+Ó 5 1#$- %(+Ó 2(+#$- %(+Ó 3 # + %(+Ó 5H@FQ@ "H@KHR +DUHSQ@ 1DU@SHN CBHQB@

,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01

• 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR ȖȖȖȖȖ

• #$ 4'0#,8ô1SQRGT? ô RPGNJ? • #20 4'0',#ô'LRCJCLAC η η /NSDMSH@KÓENQÓ Ó/#$ÓBNMBDMSQ@SHNMR /NSDMSH@KÓENQÓ Ó/#$ÓBNMBDMSQ@SHNMRÓ • ,#4'0 .',#ô(Viramune)

,-2#1 %#,'2-30', 07

%#,'2-30', 07ô"03%1ô ."#ô',&' '2-01ô$-0ô#0#!2'*#ô"71$3,!2'-,ơ̂#"̜ô-0ô.3*+-, 07ô 02#0' *ô&7.#02#,1'-,ơ̂. &̜ +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

."#ô',&' '2-01ơ̂1'*"#, $'* ô2 " * $'* ô4 0"#, $'*̜

+#!& ,'1+ô-$ô',2#0 !2'-, (MGHAHSHNMÓNEÓ"8/ Ó (MCTBSHNMÓNEÓ"8/ Ó

+ ',ô',2#0 !2',%ô 04s 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓOQNSD@RDÓHMGHAHSNQRÓ@MCÓDKUHSDFQ@UHQ ,NRSÓ--13(R

PAH: gÓ2HKCDM@ȏKÓHRÓBNMSQ@HMCHB@SDC gÓ3@C@K@ȏKÓRS@QSÓ@SÓÓLFÓC@HKXÓ@MCÓSHSQ@SDÓSNÓÓLFÓC@HKXÓA@RDCÓNMÓSNKDQ@AHKHSX MANAGEMENT CITRSÓCNRDÓ@BBNQCHMFÓSNÓDȑB@BXSNWHBHSX ED: gÓ5@QCDM@ȏKÓHRÓBNMSQ@HMCHB@SDC gÓ2HKCDM@ȏKÓTRDÓÓLFÓDUDQXÓÓGNTQR gÓ3@C@K@ȏKÓÓLFÓDUDQXÓÓGNTQR ÓL@WHLTLÓÓSHLDRÓODQÓVDDJÓ

/#$ÓSNWHBHSXÓGD@C@BGD ÓȐTRGHMF ÓCXRODORH@ ÓM@R@KÓBNMFDRSHNM Ó /#$ÓDȑB@BX +-,'2-0',% ȐTRGHMF ÓCH@QQGD@ ÓCHYYHMDRR

.17!&-20-.'!ô"03%1ô 1#" 2'4#1 &7.,-2'!1 ô ,2'"#.0#11 ,21 ô ,"ô ,2'.17!&-2'!1

η X • "-*32#%0 4'0ô 4RDÓ /NSDMSH@KÓENQÓ (Tivicay, Triumeq) ȖȖȖȖȖ dolutegravir ȖȖȖ antiretroviral, 50 mg b.i.d. UNHCÓBN administration η /NSDMSH@KÓENQÓ • #*4'2#%0 4'0ô ô!- '!'12 2 η X X η antipsychotic η X Ȗ /NSDMSH@KÓENQÓ ȖȖ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ 1RPG@GJB ô%CLTMW? /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ +TQ@RHCNMDÓÓ /NSDMSH@KÓENQÓ ADMYNCH@YDOHMD elvitegravir antidepressant antipsychotic elvitegravir ADMYNCH@YDOHMD OHLNYHCDÓ@QDÓ contraindicated

1@KSDFQ@UHQÓ X may be used 1@KSDFQDUHQÓ • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖ VHSGNTSÓCNRDÓ ȖȖȖ may be used @CITRSLDMS VHSGNTSÓCNRDÓ @CITRSLDMS .17!&-20-.'!ô

1#" 2'4#1 &7.,-2'!1 ,2'"#.0#11 ,21 ,2'.17!&-2'!1 ,NRSÓ221(RÓBHS@KNOQ@L Ó QHOHOQ@YNKD Ó KOQ@YNK@L ÓAQNL@YDO@L Ó DRBHS@KNOQ@L ÓȐTNWDSHMD Ó lurasidone, +NQ@YDO@L Ó ATROHQNMD ÓBKNM@YDO@L Ó ,HC@YNK@L Ó ,NRSÓ3" R Ó RDQSQ@KHMD ÓUDMK@E@WHMD Ó PTDSH@OHMD ÓOHLNYHCD Ó "KNY@OHMD Ó NW@YDO@L Ó DRS@YNK@L ÓȐTQ@YDO@L Ó !TOQNOHNM 2S Ó)NGMRÓVNQS ,NC@ȏMHK SQH@YNK@L CTKNWDSHMD CDRUDMK@E@WHMD Ó paliperidone, NK@MY@OHMD SDL@YDO@L CH@YDO@L ÓMHSQ@YDO@L Ó SQ@Y@CNMD ÓQDANWDSHMD Ó risperidone, YNKOHCDL ÓÓYNOHBKNMD LHQS@YHOHMD YHOQ@RHCNMD .0-2# 1#ô',&' '2-01 "NAHBHRS@S "NAHBHRS@S 0'2-, 4'0 (Norvir) or ANNRSDCÓ/(RÓ η ANNRSDCÓ/(RÓ AM@GAGQR?R @MMQRCBô.'Q ô may be used /NSDMSH@KÓENQÓ may be used C E VHSGNTSÓCNRDÓ antipsychotic VHSGNTSÓCNRDÓ fôô 2 8 , 4'0ô η X @CITRSLDMS X η @CITRSLDMS X (Evotaz, Reyataz) Ȗ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ Ȗ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ ADMYNCH@YDOHMD η PIs antidepressant η PIs fôô" 03, 4'0ô ADMYNCH@YDOHMD 1HSNM@UHQ +TQ@RHCNMDÓÓ 1HSNM@UHQ ̜.PCXAM@GV ô.PCXGQR? ANNRSDCÓ/(RÓ OHLNYHCDÓ@QDÓ ANNRSDCÓ/(RÓ fô*-.', 4'0ô̜Kaletra̝ ONSDMSH@KÓENQÓ contraindicated ONSDMSH@KÓENQÓ bupropion antipsychotic ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 X X fôô0'*.'4'0',#ô Potential ȖȖȖȖȖ /NSDMSH@KÓENQÓ ȖȖȖ !MKNJCP? ô#BSP?LR ENQÓ rilpivirine rilpivirine .17!&-20-.'!ô

.17!&-20-.'!ô"03%1ô 1#" 2'4#1 &7.,-2'!1 ô ,2'"#.0#11 ,21 ô ,"ô ,2'.17!&-2'!1

1#" 2'4#1 &7.,-2'!1 ,2'"#.0#11 ,21 ,2'.17!&-2'!1 ,NRSÓ221(RÓBHS@KNOQ@L Ó QHOHOQ@YNKD Ó KOQ@YNK@L ÓAQNL@YDO@L Ó DRBHS@KNOQ@L ÓȐTNWDSHMD Ó lurasidone, +NQ@YDO@L Ó ATROHQNMD ÓBKNM@YDO@L Ó ,HC@YNK@L Ó ,NRSÓ3" R Ó RDQSQ@KHMD ÓUDMK@E@WHMD Ó PTDSH@OHMD ÓOHLNYHCD Ó "KNY@OHMD Ó NW@YDO@L Ó DRS@YNK@L ÓȐTQ@YDO@L Ó !TOQNOHNM 2S Ó)NGMRÓVNQS ,NC@ȏMHK SQH@YNK@L CTKNWDSHMD CDRUDMK@E@WHMD Ó paliperidone, NK@MY@OHMD SDL@YDO@L CH@YDO@L ÓMHSQ@YDO@L Ó SQ@Y@CNMD ÓQDANWDSHMD Ó risperidone, YNKOHCDL ÓÓYNOHBKNMD LHQS@YHOHMD YHOQ@RHCNMD ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 $SQ@UHQHMDÓÓ may be used fôô#$ 4'0#,8ô VHSGNTSÓCNRDÓ 1SQRGT? ô RPGNJ? η η @CITRSLDMS X η η X fô#20 4'0',#ô̜'LRCJCLAC̝ Ȗ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ Ȗ η /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ Ȗ /NSDMSH@KÓENQÓ fô,#4'0 .',#ô̜Viramune ̝ ADMYNCH@YDOHMD ADMYNCH@YDOHMD $E@UHQDMY Ó --13( antidepressant antipsychotic --13( MDUHQ@OHMDÓÓ /NSDMSH@KÓENQÓ bupropion .17!&-20-.'!ô

.17!&-20-.'!ô"03%1ô 1#" 2'4#1 &7.,-2'!1 ô ,2'"#.0#11 ,21 ô ,"ô ,2'.17!&-2'!1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

#,8-"' 8#.',#1 ,2'"#.0#11 ,21 ,2'.17!&-2'!1

(MGHAHSHNMÓNEÓLHWDCÓ (MGHAHSHNMÓNEÓLHWDCÓ (MCTBSHNMÓNEÓLHWDCÓ "8/Ó@KOQ@YNK@L Ó (MGHAHSHNMÓNEÓLHWDCÓ "8/ÓO@SGV@XRÓ "8/ÓO@SGV@XRÓ AQNL@YDO@L Ó "8/ÓO@SGV@XRÓ (MCTBSHNMÓNEÓLHWDCÓ @QHOHOQ@YNKD Ó @QHOHOQ@YNKD Ó buspirone, BHS@KNOQ@L Ó "8/ÓO@SGV@XRÓ buspirone, buspirone, (MGHAHSHNMÓNEÓ BKNM@YDO@L Ó escitalopram, (MCTBSHNMÓNEÓ +NQ@YDO@L Ó ȐTNWDSHMD Ó (MCTBSHNMÓNEÓ (MCTBSHNMÓNEÓ lurasidone, lurasidone, +#!& ,'1+ô-$ô "8/ Ó DRS@YNK@L Ó ȐTNWDSHMD Ó "8/ Ó NW@YDO@L Ó sertraline, "8/!Ó "8/ Ó LNC@ȏMHK Ó LNC@ȏMHK Ó LHC@YNK@L Ó DRYNOHBKNMD Ó sertraline, BKNY@OHMD Ó ',2#0 !2'-, SDL@YDO@L SQ@YNCNMD Ó ATOQNOHNM 2S Ó)NGMRÓVNQS PTDSH@OHMD Ó PTDSH@OHMD Ó SQH@YNK@L ȐTQ@YDO@L Ó CDRUDMK@E@WHMD Ó NK@MY@OHMD QDANWDSHMD Ó OHLNYHCD Ó OHLNYHCD Ó CH@YDO@L Ó UDMK@W@ȏMD Ó LHQS@Y@OHMD paliperidone, paliperidone, MHSQ@YDO@L Ó SQ@Y@CNMD Ó risperidone, risperidone, YNKOHCDL ÓÓ LHQS@YHOHMD YHOQ@RHCNMD YHOQ@RHCNMD YNOHBKNMD

1HSNM@UHQÓ@MCÓ 1HSNM@UHQÓ@MCÓ 1HSNM@UHQÓ@MCÓ 1HSNM@UHQ ANNRSDCÓ 1HSNM@UHQÓ@MCÓ #NKTSDFQ@UHQ Ó + ',ô BNAHBHRS@S BNAHBHRS@S BNAHBHRS@S protease BNAHBHRS@S ,@XÓADÓTRDCÓ DKUHSDFQ@UHQ 1HSNM@UHQ ANNRSDCÓ boosted protease boosted protease boosted protease ,NRSÓ--13(R inhibitors, boosted protease ,NRSÓ--13(R ',2#0 !2',%ô VHSGÓ@KKÓ 15R cobicistat, all PIs protease inhibitors ARVs inhibitors and inhibitors and inhibitors and DE@UHQDMY Ó inhibitors and elvitegravir elvitegravir elvitegravir nevirapine @MCÓ--13(R elvitegravir .17!&-20-.'!ô

.17!&-20-.'!ô"03%1ô 1#" 2'4#1 &7.,-2'!1 ô ,2'"#.0#11 ,21 ô ,"ô ,2'.17!&-2'!1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

#,8-"' 8#.',#1 ,2'"#.0#11 ,21 ,2'.17!&-2'!1

CITRSÓ CITRSÓ CITRSÓ ADMYNCH@YDOHMDÓ antidepressant antidepressant dose according to dose according to dose according to CITRSÓ antidepressant CITRSÓ CITRSÓ CITRSÓ Contraindicated. QDRONMRDSNWHBHSX ÓÓ QDRONMRDSNWHBHSX ÓÓ QDRONMRDÓSNWHBHSX Ó Contraindicated ,@XÓTRDÓVHSGNTSÓ dose according antipsychotic dose antipsychotic dose antipsychotic dose 4RDÓ@KSDQM@SDÓ .SGDQÓ .SGDQÓ .SGDQÓ VHSGÓLNRSÓ MANAGEMENT CNRDÓ@CITRSLDMS to response according to according to according to ADMYNCH@YDOHMD ADMYNCH@YDOHMDRÓ antidepressants antidepressants antiretrovirals response response may be used may be used may be used L@WHLTLÓ QDRONMRDSNWHBHSX ÓLFÓC@HKX VHSGNTSÓCNRDÓ VHSGNTSÓCNRDÓ VHSGNTSÓCNRDÓ @CITRSLDMS @CITRSLDMS @CITRSLDMS

Antidepressant Antipsychotic SNWHBHSXÓ anticholinergic SNWHBHSXÓÓ !DMYNCH@YDOHMDÓ somnolence, DȎDBSR ÓNQSGNRS@SHBÓ SNWHBHSXÓ@S@WH@ Ó hypotension, RVD@SHMF ÓBGDRSÓ CHYYHMDRR Ó pain, tachycardia, tachycardia, Antidepressant Antidepressant Antipsychotic Antipsychotic CQNVRHMDRR Ó CHYYHMDRR Ó +-,'2-0',% agitation, DȑB@BX DȑB@BX DȑB@BX DȑB@BX E@SHFTD ÓLTRBKDÓ insomnia, headache, VD@JMDRR ÓRKNVDCÓ headache, nausea, somnolence, reaction diarrhea, dry CHYYHMDRR ÓCH@QQGD@ Ó mouth, numbness, DWBDRRHUDÓRVD@SHMF Ó VDHFGSÓF@HM VDHFGSÓF@HM

!-,20 !#.2'4#1

!-+ ',#"ô-0 *ô!-,20 !#.2'4#1 ô.* ,ô "+. ô"CNM .PMTCP?

',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô (Tivicay, Triumeq) ȖȖ η Ȗ • #*4'2#%0 4'0ô ô!- '!'12 2ô1RPG@GJB ô%CLTMW? /NSDMSH@KÓENQÓ ethinyl estradiol and norgestimate ,@XÓHMBQD@RDÓOQNFDRSDQNMDÓKDUDKR 4RDÓ."ÓVHSGÓminimumÓÓLBFÓDSGHMXKÓDRSQ@CHNK • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖ .0-2# 1#ô',&' '2-01 η 4RDÓ."ÓVHSGÓminimumÓÓLBFÓDSGHMXKÓDRSQ@CHNKÓ 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R @MMQRCBô.'Q ô ENQÓ@S@Y@M@UHQÓOKTRÓQHSNM@UHQ X C E ôfô 2 8 , 4'0ô#TMR?X ô0CW?R?X 4RDÓ."ÓVHSGÓL@WHLTLÓÓLBFÓDSGHMXKÓDRSQ@CHNKÓ -NSÓQDBNLLDMCDCÓAXÓL@MTE@BSTQDQ ENQÓ@S@Y@M@UHQÓVHSGNTSÓQHSNM@UHQ "NMRHCDQÓ@KSDQM@SDÓLDSGNCÓNEÓBNMSQ@BDOSHNM -NÓC@S@ÓNMÓTRDÓVHSGÓ S@Y@M@UHQÓOKTRÓBNAHBHRS@S Ȗ fô" 03, 4'0ô̜.PCXAM@GV ô.PCXGQR?̝ X /NSDMSH@KÓENQÓ ethinyl estradiol and norethindrone ,@XÓHMBQD@RDÓOQNFDRSDQNMDÓKDUDKRÓVGDMÓTRDCÓFHUDMÓVHSGÓBNAHBHRS@S fô*-.', 4'0ô̜Kaletra̝ 4RDÓ@KSDQM@SD@CCHSHNM@KÓLDSGNCRÓNEÓBNMSQ@BDOSHNM Ȗ !-,20 !#.2'4#1

!-,20 !#.2'4#1

!-+ ',#"ô-0 *ô!-,20 !#.2'4#1 ô.* ,ô "+. ô"CNM .PMTCP?

,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01

• 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR ȖȖ

X • #$ 4'0#,8ô1SQRGT? ô RPGNJ?̝ /NSDMSH@KÓENQÓE@HKTQDÓNEÓOQNFDRSDQNMDÓBNLONMDMSÓL@XÓMDDCÓSNÓHMBQD@RDÓ Ȗ OQNFDRSDQNMDÓCNRDÓVGDMÓTRDCÓENQÓDLDQFDMBXÓBNMSQ@BDOSHNMÓ/K@MÓ!

• #20 4'0',#ô'LRCJCLAC ȖȖ

η •ô,#4'0 .',#ô(Viramune) /NSDMSH@KÓENQÓ ethinyl estradiol and norethindrone Ȗ 4RDÓ@KSDQM@SD@CCHSHNM@KÓLDSGNCRÓNEÓBNMSQ@BDOSHNM !-,20 !#.2'4#1

!-,20 !#.2'4#1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

!-+ ',#"ô-0 *ô!-,20 !#.2'4#1 ô.* ,ô "+.

+#!& ,'1+ô-$ô',2#0 !2'-, (MCTBSHNMÓNEÓ"8/ Ó4&3 (MGHAHSHNMÓNEÓ"8/ (MGHAHSHNMÓNEÓ"8/

1HSNM@UHQ ANNRSDCÓOQNSD@RDÓHMGHAHSNQR Ó S@Y@M@UHQ "NAHBHRS@S ANNRSDCÓOQNSD@RDÓHMGHAHSNQR + ',ô',2#0 !2',%ô 04s DKUHSDFQ@UHQBNAHBHRS@S ÓDE@UHQDMYÓ

4RDÓ@KSDQM@SDÓMNM GNQLNM@KÓLDSGNCRÓNEÓBNMSQ@BDOSHNM MANAGEMENT "NMRHCDQÓ@KSDQM@SDÓLDSGNCRÓNEÓBNMSQ@BDOSHNM /K@MÓ!Ó@MCÓDE@UHQDMYÓL@XÓMDDCÓSNÓHMBQD@RDÓOQNFDRSDQNMDÓCNRD

+-,'2-0',% ,NMHSNQÓENQÓKNRRÓNEÓBNMSQ@BDOSHUDÓDȑB@BX ,NMHSNQÓENQÓOQNFDRSDQNMD QDK@SDCÓRHCDÓDȎDBSR

,-2#1

,2'',$#!2'4#1ô 8-*#ô ,2'$3,% *1

$*3!-, 8-*# '20 !-, 8-*# )#2-!-, 8-*# .-1 !-, 8-*# 4-0'!-, 8-*# ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô ̜Tivicay, Triumeq ̝ ȖȖȖȖȖ η η • #*4'2#%0 4'0 η /NSDMSH@KÓENQÓ Ó@YNKDÓBNMBDMSQ@SHNMR /NSDMSH@KÓENQÓ Ó@YNKDÓBNMBDMSQ@SHNMR Ó η η !- '!'12 2ô̜1RPG@GJB ô /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ ÓHSQ@BNM@YNKDÓ /NSDMSH@KÓENQÓ ÓJDSNBNM@YNKDÓÓ /NSDMSH@KÓENQÓ /NSDMSH@KÓENQÓ Genvoya̝ @YNKDÓBNMBDMSQ@SHNMR BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ @YNKDÓBNMBDMSQ@SHNMR @YNKDÓBNMBDMSQ@SHNMR HSQ@BNM@YNKDÓÓLFÓC@HKX ÓLFÓJDSNBNM@YNKDÓC@HKX • 0 *2#%0 4'0ô'QCLRPCQQ ȖȖȖȖȖ .0-2# 1#ô',&' '2-01ơ̂ --12#"ô5'2&ô0'2-, 4'0ô-0ô!- '!'12 2̜

η η X • 2 8 , 4'0 /NSDMSH@KÓENQÓ ÓHSQ@BNM@YNKDÓ /NSDMSH@KÓENQÓ ÓJDSNBNM@YNKDÓÓ η /NSDMSH@KÓENQÓ ÓUNQHBNM@YNKDÓ Ó S@Y@M@UHQÓBNMBDMSQ@SHNMR Ó (Evotaz, Reyataz) Ȗ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMRÓVHSGÓQHSNM@UHQ ANNRSDCÓ ,NMHSNQÓENQÓSNWHBHSX HSQ@BNM@YNKDÓÓLFÓC@HKX ÓLFÓJDSNBNM@YNKDÓC@HKX Pls and ÓÓUNQHBNM@YNKDÓBNMBDMSQ@SHNMRÓ VHSGÓBNAHBHRS@S ANNRSDCÓ/KR η η η fôô" 03, 4'0ô /NSDMSH@KÓENQÓ ÓHSQ@BNM@YNKDÓ /NSDMSH@KÓENQÓ ÓJDSNBNM@YNKDÓÓ Possible in darunavir X ̜.PCXAM@GV ô.PCXGQR?̝ Ȗ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó,NMHSNQÓENQÓ /NSDMSH@KÓENQÓ ÓUNQHBNM@YNKDÓ HSQ@BNM@YNKDÓÓLFÓC@HKX ÓLFÓJDSNBNM@YNKDÓC@HKX SNWHBHSX concentrations η η η Possible in lopinavir X fô*-.', 4'0ô̜Kaletra̝ /NSDMSH@KÓENQÓ ÓHSQ@BNM@YNKDÓ /NSDMSH@KÓENQÓ ÓJDSNBNM@YNKDÓÓ Ȗ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó4RDÓL@WHLTLÓ BNMBDMSQ@SHNMR Ó,NMHSNQÓENQÓ /NSDMSH@KÓENQÓ ÓUNQHBNM@YNKDÓ HSQ@BNM@YNKDÓÓLFÓC@HKX ÓLFÓJDSNBNM@YNKDÓC@HKX SNWHBHSX concentrations ,2'',$#!2'4#1

$*3!-, 8-*# '20 !-, 8-*# )#2-!-, 8-*# .-1 !-, 8-*# 4-0'!-, 8-*# ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 η /NSDMSH@KÓENQ rilpivirine η η η /NSDMSH@KÓENQ rilpivirine and /NSDMSH@KÓENQ rilpivirine and /NSDMSH@KÓENQ rilpivirine and η and Ó@YNKDÓ /NSDMSH@KÓENQ rilpivirine and Ó@YNKDÓ • 0'*.'4'0',# @YNKDÓBNMBDMSQ@SHNMR Ó4RDÓVHSGÓ @YNKDÓBNMBDMSQ@SHNMR Ó4RDÓVHSGÓ @YNKDÓBNMBDMSQ@SHNMR Ó4RDÓVHSGÓ BNMBDMSQ@SHNMR Ó4RDÓVHSGÓ BNMBDMSQ@SHNMR Ó4RDÓVHSGÓB@TSHNMÓ@MCÓ !MKNJCP? ô#BSP?LR B@TSHNMÓ@MCÓLNMHSNQÓENQÓ B@TSHNMÓ@MCÓLNMHSNQÓENQÓ B@TSHNMÓ@MCÓLNMHSNQÓENQÓ B@TSHNMÓ@MCÓLNMHSNQÓENQÓ LNMHSNQÓENQÓQHKOHUHQHMDÓSNWHBHSXÓ@MCÓ QHKOHUHQHMDÓSNWHBHSXÓ@MCÓ QHKOHUHQHMDÓSNWHBHSXÓ@MCÓ QHKOHUHQHMDÓSNWHBHSXÓ@MCÓ QHKOHUHQHMDÓSNWHBHSXÓ@MCÓ AQD@JSGQNTFGÓHMEDBSHNMR AQD@JSGQNTFGÓHMEDBSHNMR AQD@JSGQNTFGÓHMEDBSHNMR AQD@JSGQNTFGÓHMEDBSHNMR AQD@JSGQNTFGÓHMEDBSHNMR η /NSDMSH@KÓENQÓ UNQHBNM@YNKDÓ@MCÓ fôô#$ 4'0#,8ô X X X ÓDE@UHQDMYÓBNMBDMSQ@SHNMR Ó ̜1SQRGT? ô RPGNJ?̝ Ȗ /NSDMSH@KÓENQÓ Ó@YNKDÓÓ /NSDMSH@KÓENQÓ Ó@YNKDÓÓ /NSDMSH@KÓENQÓ Ó@YNKDÓÓ ÓUNQHBNM@YNKDÓSNÓÓÓLFÓPÓGNTQRÓ concentrations concentrations concentrations and DE@UHQDMYÓSNÓÓLFÓC@HKXÓHEÓ SGDQ@OXÓK@RSRÓLNQDÓSG@MÓ@ÓEDVÓC@XR η η η η Possible etravirine Possible ÓDSQ@UHQHMDÓ@MCNQÓ Possible ÓDSQ@UHQHMDÓ@MCNQÓ η Possible ÓDSQ@UHQHMDÓ@MCÓUNQHBNM@YNKDÓ Possible etravirine fô#20 4'0',#ô̜'LRCJCLAC̝ BNMBDMSQ@SHNMR Ó,NMHSNQÓ HSQ@BNM@YNKDÓBNMBDMSQ@SHNMR Ó JDSNBNM@YNKDÓBNMBDMSQ@SHNMR Ó BNMBDMSQ@SHNMR Ó,NMHSNQÓENQÓRHCDÓDȎDBSRÓ BNMBDMSQ@SHNMR Ó,NMHSNQÓENQÓRHCDÓ ENQÓRHCDÓDȎDBSRÓNEÓ "NMRHCDQÓCNRDÓHMBQD@RDÓNEÓ "NMRHCDQÓCNRDÓHMBQD@RDÓNEÓ NEÓDSQ@UHQHMD Ó,@XÓMDDCÓSNÓCNRDÓ@CITRSÓ DȎDBSRÓNEÓDSQ@UHQHMD etravirine HSQ@BNM@YNKD JDSNBNM@YNKD UNQHBNM@YNKD η Possible nevirapine η X X Possible nevirapine fô,#4'0 .',#ô̜Viramune ̝ BNMBDMSQ@SHNMR Ó,NMHSNQÓ X /NSDMSH@KÓENQÓ Ó@YNKDÓÓ /NSDMSH@KÓENQÓ Ó@YNKDÓÓ BNMBDMSQ@SHNMR Ó,NMHSNQÓENQÓ ENQÓ@CUDQRDÓDȎDBSRÓ /NSDMSH@KÓENQÓ Ó@YNKDÓÓBNMBDMSQ@SHNMR concentrations concentrations SNWHBHSX HMBKTCHMFÓGDO@SNSNWHBHSX ,2'',$#!2'4#1

,2'',$#!2'4#1ô 8-*#ô ,2'$3,% *1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

$*3!-, 8-*# '20 !-, 8-*# ô)#2-!-, 8-*# ô.-1 !-, 8-*# 4-0'!-, 8-*#

(MCTBSHNMÓNEÓ"8/"ÓAXÓRNLDÓ (MGHAHSHNMÓNEÓ"8/ Ó +#!& ,'1+ô-$ô (MGHAHSHNMÓNEÓ"8/ Ó 2TARSQ@SDÓNEÓ"8/ ÓHMCTBSHNMÓ (MGHAHSHNMÓNEÓ"8/ @MSHQDSQNUHQ@KRÓUNQHBNM@YNKDÓ (MGHAHSHNMÓNEÓ"8/" @MSHQDSQNUHQ@KRÓ@MCÓ @MSHQDSQNUHQ@KR AXÓLNRSÓ--13(R ',2#0 !2'-, @KRNÓHMGHAHSRÓ"8/ UNQHBNM@YNKD

1HSNM@UHQÓ@MCÓBNAHBHRS@S 1HKOHUHQHMD ÓDSQ@UHQHMD ÓMDUHQ@OHMD Ó "NAHBHRS@S ANNRSDCÓ/(RÓ@MC ANNRSDCÓ/(R ÓDKUHSDFQ@UHQ $E@UHQDMY ÓDSQ@UHQHMD ÓMDUHQ@OHMD 1HSNM@UHQ ANNRSDCÓ/(R ÓDE@UHQDMY $SQ@UHQHMD + ',ô',2#0 !2',%ô 041 DKUHSDFQ@UHQBNAHBHRS@S cobicistat DKUHSDFQ@UHQBNAHBHRS@S

1HSNM@UHQ ANNRSDCÓ/(R UNHCÓDE@UHQDMYÓ@MCÓMDUHQ@OHMDÓHEÓ avoid coadministration. 4RDÓL@WHLTLÓÓLFÓ 4RDÓRS@MC@QCÓCNRDRÓ ONRRHAKD ÓÓ4RDÓDSQ@UHQHMDÓVHSGÓ JDSNBNM@YNKD $E@UHQDMYÓHMBQD@RDÓUNQHBNM@YNKDÓ MANAGEMENT NEÓANSGÓCQTFR caution and consider increasing ÓNQÓHSQ@BNM@YNKDÓC@HKX SNÓÓLFÓPÓGNTQRÓ@MCÓ @YNKDÓCNRDÓHEÓMDBDRR@QX CDBQD@RDÓDE@UHQDMYÓSNÓÓLFÓ daily.

+-,'2-0',% MSHQDSQNUHQ@KÓSNWHBHSX YNKDÓSNWHBHSX YNKDÓDȑB@BX 5NQHBNM@YNKDÓDȑB@BX $SQ@UHQHMDÓSNWHBHSX 5NQHBNM@YNKDÓSNWHBHSX ,2'',$#!2'4#1

,2'',$#!2'4#1ô + !0-*'"#ô ,2' '-2'!1

8'2&0-+7!', !* 0'2&0-+7!', #072&0-+7!',

',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ ȖȖȖ η fô#*4'2#%0 4'0 ô!- '!'12 2ô̜1RPG@GJB ô%CLTMW? Ȗ #NRDÓ@CITRSLDMSÓMDBDRR@QXÓ Ȗ VHSGÓQDM@KÓHLO@HQLDMS

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖ .0-2# 1#ô',&' '2-01

Ȗ η Ȗ 0'2-, 4'0 (Norvir) or #NRDÓ@CITRSLDMSÓMDBDRR@QX AM@GAGQR?R @MMQRCBô.'Q ôC E fôô 2 8 , 4'0ô η (Evotaz, Reyataz) Ȗ #NRDÓ@CITRSLDMSÓMDBDRR@QXÓ Ȗ fôô" 03, 4'0ô VHSGÓQDM@KÓHLO@HQLDMS ̜.PCXAM@GV ô.PCXGQR? fô*-.', 4'0ô̜Kaletra̝ η Ȗ #NRDÓ@CITRSLDMSÓMDBDRR@QXÓ Ȗ VHSGÓQDM@KÓHLO@HQLDMS ,2'',$#!2'4#1

8'2&0-+7!', !* 0'2&0-+7!', #072&0-+7!',

,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 η η • 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR Ȗ ,@XÓHMBQD@RDÓQHKOHUHQHMDÓKDUDKRÓ ,@XÓHMBQD@RDÓQHKOHUHQHMDÓKDUDKRÓ /NSDMSH@KÓ03ÓOQNKNMF@SHNM /NSDMSH@KÓ03ÓOQNKNMF@SHNM

η -NÓCNRDÓ@CITRSLDMSÓMDDCDC Ó • #$ 4'0#,8ô1SQRGT? ô RPGNJ? Ȗ /NSDMSH@KÓENQÓ clarithromycin and Ȗ Ó .'ÓLDS@ANKHSDÓBNMBDMSQ@SHNMRÓ @MCÓHMBQD@RDCÓQHRJÓNEÓQ@RG

η • #20 4'0',#ô'LRCJCLAC Ȗ /NSDMSH@KÓENQÓ clarithromycin and Ȗ Ó .'ÓLDS@ANKHSDÓBNMBDMSQ@SHNMR

η /NSDMSH@KÓENQÓ clarithromycin and fô,#4'0 .',#ô̜Viramune ̝ Ȗ clarithromycin metabolite concentrations. Ȗ /NSDMSH@KÓENQÓ nevirapine concentrations ,2'',$#!2'4#1

,2'',$#!2'4#1ô + !0-*'"#ô ,2' '-2'!1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

8'2&0-+7!', !* 0'2&0-+7!', !* 0'2&0-+7!', ô#072&0-+7!',

(MGHAHSHNMÓNEÓ"8/ ÓQHSNM@UHQ ÓBNAHBHRS@S Protease inhibitors inhibit the metabolism (MCTBSHNMÓNEÓ"8/ ÓQDRTKSHMFÓHMÓCDBQD@RDCÓ NEÓBK@QHSGQNLXBHMÓUH@Ó"8/ Ó@MCÓHMBQD@RDÓ BK@QHSGQNLXBHMÓ@MCÓHMBQD@RDCÓ"+ Ó.'Ó (MGHAHSHNMÓNEÓ"8/ Ó 2TARSQ@SDÓNEÓ"8/ ÓLHMNQ +#!& ,'1+ô-$ô',2#0 !2'-, BNMBDMSQ@SHNMRÓNEÓBK@QHSGQNLXBHM Ó3GHRÓL@XÓ LDS@ANKHSD ÓVGHBGÓG@RÓQDCTBDCÓ@BSHUHSXÓ BK@QHSGQNLXBHM ÓDQXSGQNLXBHM KD@CÓSNÓ@ÓCDBQD@RDÓHMÓ"+ Ó.'ÓLDS@ANKHSD Ó @F@HMRSÓ,XBNA@BSDQHTLÓ@UHTLÓBNLOKDWÓ, " reducing antibacterial activity versus FQ@L MDF@SHUDÓNQF@MHRLR

1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ/(RÓ $KUHSDFQ@UHQBNAHBHRS@SÓ@MCÓ $E@UHQDMY ÓDSQ@UHQHMD ÓMDUHQ@OHMD 1HKOHUHQHMD + ',ô',2#0 !2',%ô 04s @MCÓDKUHSDFQ@UHQBNAHBHRS@S boosted protease inhibitors

R?X?L?TGP reduce clarithromycin dose by ϾÓSNÓ@UNHCÓ03BÓOQNKNMF@SHNMÓ@MCÓBNMRHCDQÓ @KSDQM@SDÓ@FDMSÓENQÓMNM , "ÓHMEDBSHNMR #JTGRCEP?TGP AM@GAGQR?R ,@XÓVHRGÓSNÓBNMRHCDQÓRVHSBGHMFÓ 1DCTBDÓCNRDÓNEÓBK@QHSGQNLXBHMÓAXÓϾÓHEÓ"Q"KÓ 4RDÓRS@MC@QCÓCNRDRÓNEÓANSGÓCQTFR SNÓ@YHSGQNLXBHM ÓO@QSHBTK@QKXÓHEÓSQD@SHMFÓ 4RDÓVHSGÓB@TSHNM MANAGEMENT HRÓADSVDDMÓ L+LHM Ó#NÓMNSÓ@CLHMHRSDQÓ , "ÓHMEDBSHNM BK@QHSGQNLXBHMÓHEÓ"Q"KÓL+LHM "?PSL?TGPô?LBôJMNGL?TGP reduce BK@QHSGQNLXBHMÓCNRDÓAXÓϾÓHEÓ"Q"KÓ L+ LHMÓAXÓϾÓHEÓ"Q"KÓL+LHM Ó

,NMHSNQÓENQÓ03ÓHMSDQU@KÓOQNKNMF@SHNMÓHMÓ ,NMHSNQÓO@SHDMSRÓENQÓRHFMRÓNEÓBK@QHSGQNLXBHMÓ ,NMHSNQÓENQÓ03ÓHMSDQU@KÓOQNKNMF@SHNMÓHMÓ "K@QHSGQNLXBHMÓDȑB@BXÓ@MCÓONSDMSH@KÓQ@RG +-,'2-0',% O@SHDMSRÓVHSGÓNSGDQÓOQD DWHRSHMFÓQHRJÓE@BSNQR SNWHBHSXÓHMBKTCHMFÓ03ÓHMSDQU@KÓOQNKNMF@SHNM O@SHDMSRÓVHSGÓNSGDQÓOQD DWHRSHMFÓQHRJÓE@BSNQR ,2'',$#!2'4#1

,2'',$#!2'4#1ô +#"'! 2'-,1ô$-0ô23 #0!3*-1'1

0'$ +.', RIFABUTIN '1-,' 8'" .70 8', +'"# #2& + 32-*

',2#%0 1#ô',&' '2-01 η • "-*32#%0 4'0ô(Tivicay, Triumeq) #DBQD@RDCÓCNKTSDFQ@UHQ Ó ȖȖȖȖ 4RDÓCNKTSDFQ@UHQÓÓLFÓA H C

fôô#*4'2#%0 4'0 ô!- '!'12 2ô X X /NSDMSH@KÓENQÓ elvitegravir ȖȖȖ ̜1RPG@GJB ô%CLTMW?̝ /NSDMSH@KÓENQÓ elvitegravir and ÓQHE@ATSHMÓBNMBDMSQ@SHNMR

η fô0 *2#%0 4'0ô̜'QCLRPCQQ̝ #DBQD@RDCÓQ@KSDFQ@UHQ ȖȖȖȖ 4RDÓQ@KSDFQ@UHQÓÓLFÓA H C .0-2# 1#ô',&' '2-01 • 2 8 , 4'0ô (Evotaz, Reyataz) η • " 03, 4'0ô.PCXAM@GV ô.PCXGQR? X Ó1HE@ATSHMÓBNMBDMSQ@SHNMR Ó4RDÓQHE@ATSHMÓÓLFÓ ȖȖȖ /NSDMSH@KÓENQÓ protease inhibitor concentrations • *-.', 4'0ô(Kaletra) C@HKXÓVHSGÓANNRSDCÓOQNSD@RDÓHMGHAHSNQR ,2'',$#!2'4#1

0'$ +.', RIFABUTIN '1-,' 8'" .70 8', +'"# #2& + 32-*

,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01

η • 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR X Ó1HKOHUHQHMDÓBNMBDMSQ@SHNMRÓ ȖȖȖ /NSDMSH@KÓENQÓ rilpivirine concentrations to rilpivirine 50 mg daily

η /NSDMSH@KÓENQÓ ÓQHE@ATSHMÓBNMBDMSQ@SHNMR Ó • #$ 4'0#,8ô1SQRGT? ô RPGNJ? Ȗ ÓSNÓQHE@ATSHMÓ ÓLFÓC@HKXÓ ȖȖȖ NQÓÓLFÓSGQDDÓSHLDRÓVDDJKX

• #20 4'0',#ô'LRCJCLAC X ȖȖȖȖ /NSDMSH@KÓENQÓ etravirine concentrations

• ,#4'0 .',#ô̜Viramune ̝ X ȖȖȖȖ /NSDMSH@KÓENQÓ nevirapine concentrations ,2'',$#!2'4#1

,2'',$#!2'4#1ô +#"'! 2'-,1ô$-0ô23 #0!3*-1'1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

0'$ +.', Integrase Inhibitors RIFABUTIN

(MCTBSHNMÓNEÓ"8/ ÓQHE@ATSHMÓ 1HE@LOHMÓHRÓ@ÓONSDMSÓ"8/ Ó 1HE@ATSHMÓHRÓ@ÓRTARSQ@SDÓ@MCÓ (MCTBSHNMÓNEÓ"8/ Ó @MCÓHMGHAHSHNMÓNEÓ"8/ Ó +#!& ,'1+ô-$ô',2#0 !2'-, inducer LNCDQ@SDÓHMCTBDQÓNEÓ"8/ QHE@ATSHMÓ@MCÓ--13(R OQNSD@RDÓHMGHAHSNQR

(MSDFQ@RDÓHMGHAHSNQRÓÓ Protease inhibitors --13(RÓQHKOHUHQHMD ÓDE@UHQDMY Ó dolutegravir, raltegravir, @S@Y@M@UHQ ÓC@QTM@UHQ Ó $KUHSDFQ@UHQBNAHBHRS@S All protease inhibitors --13(RÓQHKOHUHQHMD ÓDE@UHQDMY + ',ô',2#0 !2',%ô 04s etravirine, nevirapine elvitegravir KNOHM@UHQ

"MôLMRôAM?BKGLQRCPôUGRFô Increase dolutegravir to 50 mg PGJNGTGPGLC ôCRP?TGPGLCôMPô b.i.d. and consider alternate LCTGP?NGLCÓCTDÓSNÓE@HKTQDRÓNEÓ (MBQD@RDÓCNRDÓNEÓQHKOHUHQHMDÓ SGDQ@OXÓHEÓO@SHDMSÓHRÓHMSDFQ@RDÓ antiretroviral therapy Consider increasing cobicistat SNÓÓLFÓA H C ÓVHSGÓ to 50 mg daily HMGHAHSNQÓDWODQHDMBDC "MôLMRôAM?BKGLGQRCP #D?TGPCLX product monograph DKUHSDFQ@UHQÓÓLFÓC@HKXÓ@MCÓ QDFTK@QÓCNRDÓÓLF (MBQD@RDÓQ@KSDFQ@UHQÓSNÓÓLFÓ RTFFDRSRÓHMBQD@RHMFÓSNÓÓLFÓ 6GDMÓ@CLHMHRSDQHMFÓQHE@ATSHMÓ (MBQD@RHMFÓCNR@FDÓNEÓ+/5QÓSNÓ CDBQD@RDÓQHE@ATSHMÓSNÓÓLFÓ (MBQD@RDÓQHE@ATSHMÓSNÓ A H C Ó@MCÓTRDÓVHSGÓB@TSHNMÓHMÓ DE@UHQDMYÓC@HKXÓVGHKDÓNMÓ VHSGÓ@ÓOQNSD@RDÓHMGHAHSNQÓ ÓA H C ÓNUDQBNLDRÓ PÓC@XR ÓATSÓSGHRÓL@XÓMNSÓADÓ ÓLFÓC@HKXÓNQÓÓLFÓ MANAGEMENT O@SHDMSRÓHMHSH@SHMFÓ 15ÓSGDQ@OXÓ QHE@LOHMÓHMÓO@SHDMSRÓÓJF QDCTBDÓCNRDÓSNÓÓLFÓC@HKXÓNQÓ HMCTBSHNMÓDȎDBSÓNEÓQHE@LOHMÓATSÓ possible. WVDDJÓVGDMÓFHUDMÓ VHSGÓGHFGÓHMHSH@KÓUHQ@KÓKN@CRÓCTDÓ may result in intolerable ÓLFÓWVDDJ 'NVDUDQÓBTQQDMSÓFTHCDKHMDRÓ TMGBôAMK@GL?RGML ô VHSGÓDE@UHQDMY SNÓQHRJÓNEÓCDUDKNOLDMSÓ @CUDQRDÓDȎDBSR RTFFDRSÓSG@SÓRS@MC@QCÓÓLFÓ !MLQGBCPô?JRCPL?RCôGLRCEP?QCô Nevirapine or etravirine may be NEÓQDRHRS@MBD CNRDÓL@XÓADÓTRDCÓVHSGÓBKNRDÓ GLFG@GRMPôGDôNMQQG@JC TRDCÓVHSGNTSÓCNRDÓ@CITRSLDMS "MôLMRôAM?BKGLGQRCPô LNMHSNQHMFÓNEÓDE@UHQDMYÓKDUDKRÓ UGRFôCJTGRCEP?TGP AM@GAGQR?R @MCNQÓLNMHSNQHMFÓNEÓUHQNKNFHBÓ response ,2'',$#!2'4#1

0'$ +.', Integrase Inhibitors RIFABUTIN

Virologic response 6@SBGÓENQÓUHQNKNFHBÓ ,NMHSNQÓENQÓUHQNKNFHBÓQDRONMRDÓ to antiretrovirals and AQD@JSGQNTFGÓ@MCÓDȑB@BXÓ @MCÓDE@UHQDMYÓCQTFÓKDUDKRÓ 1HE@ATSHMÓSNWHBHSX +-,'2-0',% @MSHLXBNA@BSDQH@KÓDȎDBSÓ NEÓ@MSHQDSQNUHQ@K VHSGÓ3#,ÓHEÓ@U@HK@AKD NEÓQHE@ATSHM

,-2#1

!'"ô13..0#11',%ô"03%1

,2 !'"1 .0-2-,ô.3+.ô',&' '2-01ơ̂..'̜ & RAs +E ô J MP !?ô!-,2 ',',%ô ,2 !'"1 2 ̛#QMKCNP?XMJC ô*?LQMNP?XMJC ô-KCNP?XMJC ô ̛$?KMRGBGLC ô,GX?RGBGLC ô0?LGRGBGLC̜ ̛2SKQ ô+??JMV .?LRMNP?XMJC ô0?@CNP?XMJC ',2#%0 1#ô',&' '2-01

• "-*32#%0 4'0ô(Tivicay, Triumeq) η Ó#NKTSDFQ@UHQ ȖȖ

fôô#*4'2#%0 4'0 !- '!'12 2ô η ̜1RPG@GJB ô%CLTMW?̝ Ó$KUHSDFQ@UHQ ȖȖ

fô0 *2#%0 4'0ô̜'QCLRPCQQ̝ X ȖȖ Ó1@KSDFQ@UHQ .0-2# 1#ô',&' '2-01 0'2-, 4'0 (Norvir) or AM@GAGQR?R @MMQRCBô.'Q ôC E η X η η Ó S@Y@M@UHQÓ Ó S@Y@M@UHQ Ó S@Y@M@UHQ Ó S@Y@M@UHQ fôô 2 8 , 4'0ô VHSGÓKNVÓCNRDÓ//( (Evotaz, Reyataz) VHSGÓGHFGÓ//(

fôô" 03, 4'0ô ̜.PCXAM@GV ô.PCXGQR? ȖȖȖ fô*-.', 4'0ô̜Kaletra̝ !'"ô13..0#11',%ô "03%1

• 0'*.'4'0',#ô!MKNJCP? ô#BSP?LR η η X Ó1HKOHUHQHMD Ó1HKOHUHQHMD Ó1HKOHUHQHMD

• #$ 4'0#,8ô1SQRGT? ô RPGNJ? • #20 4'0',#ô'LRCJCLAC ȖȖȖ • ,#4'0 .',#ô(Viramune)

,-2#1 !'"ô13..0#11',%ô "03%1

!'"ô13..0#11',%ô"03%1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQô?LBô+?L?ECKCLRô

RAs .0-2-,ô.3+.ô !'"ô13..0#11',%ô"03%1 ,2 !'"1 &2 ',&' '2-01

'LRCEP?QCô'LFG@GRMPQ R?X?L?TGP increase in gastric R?X?L?TGP increase in gastric R?X?L?TGP ôPGJNGTGPGLCôô chelation leading increase in gastric pH leads 0GJNGTGPGLC increase in gastric pH leads 0GJNGTGPGLC increase in gastric pH leads +#!& ,'1+ô-$ô',2#0 !2'-, pH leads to poor absorption pH leads to poor absorption to poor absorption to poor absorption to poor absorption to poor absorption "MJSRCEP?TGP Administer ÓGNTQRÓADENQDÓNQÓÓGNTQRÓ @ȓDQÓLDCHB@SHNMRÓBNMS@HMHMFÓ ONKXU@KDMSÓB@SHNMRÓ,F Ó K Ó%DÓ NQÓ"@ÓHMBKTCHMFÓ@MS@BHCRÓNQÓ R?X?L?TGPô K@W@SHUDR ÓRTBQ@KE@SD ÓNQ@KÓHQNMÓ Coadministration is or calcium supplements and not recommended ATȎDQDCÓLDCHB@SHNMR R?X?L?TGPô &HUDÓRHLTKS@MDNTRKXÓVHSGÓ (EÓTM@UNHC@AKDÓHMBQD@RDÓ 0GJNGTGPGLC (EÓFHUDMÓVHSGÓENNC ÓL@XÓADÓ NQÓÓGNTQRÓ@ȓDQÓ'1 Ó @S@Y@M@UHQÓCNRDÓSNÓÓLFÓ R?X?L?TGPô Administer antacids 0GJNGTGPGLCô taken at same time as calcium CLHMHRSDQÓÓGNTQRÓADENQDÓ (EÓ@KRNÓNMÓSDMNENUHQ BNMS@HMHMFÓ &HUDÓQHKOHUHQHMDÓÓGNTQRÓADENQDÓ VHSGÓÓLFÓNEÓQHSNM@UHQÓ MANAGEMENT @SÓKD@RSÓÓGNTQRÓADENQD and iron supplements NQÓÓGNTQÓ@ȓDQÓ@MS@BHCR QDFHLDM ÓHMBQD@RDÓSNÓ@S@Y@M@UHQÓ NQÓÓGNTQRÓ@ȓDQÓ' 1 NQÓÓGNTQRÓ@ȓDQÓQHKOHUHQHMD 2 #NÓMNSÓDWBDDCÓCNRDRÓ #JTGRCEP?TGPÓ2DO@Q@SDÓAXÓ ÓLFÓ@MCÓQHSNM@UHQÓÓLFÓ NEÓNLDOQ@YNKDÓÓLFÓ @SÓKD@RSÓÓGNTQRÓEQNLÓ@MS@BHCRÓ HMÓDWODQHDMBDCÓO@SHDMSR or comparable BNMS@HMHMFÓ K Ó,FÓNQÓ"@ 0GJNGTGPGLCô 0?JRCEP?TGPÓ#NÓMNSÓ BNMSQ@HMCHB@SDCÓVHSGÓ//(R BN@CLHMHRSDQÓVHSGÓ,FÓNQÓ KÓ containing antacids "@KBHTL BNMS@HMHMFÓ@MS@BHCRÓ may be coadministered

0#!0# 2'-, *ô"03%1 ̛1##ôa , *%#1'!1gô$-0ô-.'-'"ô',2#0 !2'-,1ô ,"ôa.17!&-20-.'!1gô$-0ô #,8-"' 8#.',#ô',2#0 !2'-,1̜ôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôôô

COCAINE +. +',#1 & **3!',-%#,1 +7*ô,'20 2# ! ,, '1 +"+ ôMPô#AQR?QW ô *1"ô?LBô.!. %& )CR?KGLC ̛NMNNCPQ̜ ̛K?PGHS?L?̜ ̛AP?AI̜ !PWQR?J a?LECJôBSQRg aB?RCôP?NCôBPSEg 1NCAG?Jô) ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ ȖȖȖȖȖȖȖ • #*4'2#%0 4'0 !- '!'12 2ô η ̜1RPG@GJB ô%CLTMW?̝ ȖȖ Potential ÓHMÓKDUDKRÓNEÓQDBQD@SHNM@KÓCQTFR Ó2DDÓ,@M@FDLDMSÓ@MCÓ,NMHSNQHMF

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 0'2-, 4'0 (Norvir) or AM@GAGQR?R @MMQRCBô.'Q ôC E fôô 2 8 , 4'0ô (Evotaz, Reyataz) η ȖȖ Potential ÓHMÓKDUDKRÓNEÓQDBQD@SHNM@KÓCQTFR Ó2DDÓ,@M@FDLDMSÓ@MCÓ,NMHSNQHMF fôô" 03, 4'0ô ̜.PCXAM@GV ô.PCXGQR? fô*-.', 4'0ô̜Kaletra̝ 0#!0# 2'-, *ô "03%1

COCAINE +. +',#1 & **3!',-%#,1 +7*ô,'20 2# ! ,, '1 +"+ ôMPô#AQR?QW ô *1"ô?LBô.!. %& )CR?KGLC ̛NMNNCPQ̜ ̛K?PGHS?L?̜ ̛AP?AI̜ !PWQR?J a?LECJôBSQRg aB?RCôP?NCôBPSEg 1NCAG?Jô) ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 fôô#$ 4'0#,8ô̜ RPGNJ? ô1SQRGT?̝ η fôô#20 4'0',#ô̜'LRCJCLAC̝ Potential Ȗ Ȗ Ȗ ÓHMÓKDUDKRÓNEÓ Ȗ Ketamine levels Ȗ Ó+2#Ó@MCÓ/"/ÓKDUDKR fôô,#4'0 .',#ô̜Viramune ̝ GDO@SNSNWHBÓLDS@ANKHSD

η fô0'*.'4'0',#ô̜!MKNJCP?̝ Ȗ /NSDMSH@KÓ03Ó ȖȖȖȖ prolongation

,-2#1 0#!0# 2'-, *ô "03%1

12'+3* ,21 & **3!',-%#,1 !MA?GLC ô?KNFCR?KGLCQ )#2 +',# *1" ô.!.ô?LECJôBSQR %&

(MGHAHSHNMÓNEÓÓ"8/ ÓBNB@HMDÓ@MCÓ"8/Ó#Ó ,DBG@MHRLÓTMBKD@QÓATSÓONSDMSH@KÓENQÓHMGHAHSHNMÓ ,DBG@MHRLÓTMBKD@QÓATSÓONSDMSH@KÓENQÓHMGHAHSHNMÓ +#!& ,'1+ô-$ô',2#0 !2'-, @LOGDS@LHMDR Ó&'!ÓÓKD@CHMFÓSNÓHMBQD@RDCÓKDUDKRÓNEÓRSHLTK@MS NQÓHMCTBSHNMÓNEÓCQTFÓLDS@ANKHRL NQÓHMCTBSHNMÓNEÓCQTFÓLDS@ANKHRL

/QNSD@RDÓ(MGHAHSNQRÓ/(ÓVHSGÓQHSNM@UHQÓNQÓBNAHBHRS@SÓ /(RÓÓ2SQHAHKCÓL@XÓHMBQD@RDÓG@KKTBHMNFDMÓBNMBDMSQ@SHNMR /(RÓÓ2SQHAHKCÓL@XÓHMBQD@RDÓJDS@LHMDÓBNMBDMSQ@SHNMR + ',ô',2#0 !2',%ô 04s Ó$KUHSDFQ@UHQBNAHBHRS@SÓ2SQHAHKC ,NRSÓ--13(RÓL@XÓCDBQD@RDÓKDUDKR ,NRSÓ--13(RÓL@XÓCDBQD@RDÓKDUDKR

6@QMÓO@SHDMSÓNEÓONSDMSH@KÓENQÓTMOQDCHBS@AKDÓHMBQD@RDCÓKDUDKRÓ 6@QMÓO@SHDMSÓNEÓTMOQDCHBS@AKDÓHMBQD@RDCÓKDUDKRÓ 6@QMÓO@SHDMSÓNEÓTMOQDCHBS@AKDÓHMBQD@RDCÓKDUDKRÓ MANAGEMENT** NEÓSGDÓQDBQD@SHNM@KÓRTARS@MBDÓ@MCÓOQNUHCDÓG@QLÓQDCTBSHNMÓ@CUHBD NEÓG@KKTBHMNFDMÓ@MCÓOQNUHCDÓG@QLÓQDCTBSHNMÓ@CUHBD and provide harm reduction advice

2MVGAGRW #DGXCQ@SHNM ÓCQXÓLNTSG ÓSDDSGÓFQHMCHMF ÓSDMRDÓI@V ÓS@BGXB@QCH@ 2MVGAGRWô 2MVGAGRW +-,'2-0',% '@KKTBHM@SHNMR ÓORXBGNRHR ÓȐ@RGA@BJR ÓRDHYTQDR ÓGXODQSDMRHNM -@TRD@ ÓUNLHSHMF Ó2.! ÓKNRRÓNEÓBNNQCHM@SHNM ÓBNFMHSHUDÓCDBKHMD %& ÓRDHYTQDR ÓAQ@CXB@QCH@ ÓKNRRÓNEÓBNMRBHNTRMDRR

, *%#1'!1ơ̂. ',ô)'**#01̜

, 0!-2'!1 ,-,̝, 0!-2'!ô , *%#1'!1 ,NQOGHMD .SGDQÓ MSH (MȐ@LL@SNQXÓ "NCDHMD Acetaminophen Hydromorphone ,DCHB@SHNMRÓ-2 (#2 .WXBNCNMDÓ/DQBNBDSt ,DSG@CNMD 3Q@L@CNK %DMS@MXK 3XKDMNKÓ #HK@TCHCt $ F Ó KDUD Ó CUHK Ó,NSQHM 'XCQNBNCNMDÓ'XBNC@Mt 2 Ó ROHQHM GDQNHMÓ@MCÓBNB@HMD 5NKS@QDM Ó"DKDAQDW ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜Tivicay, Triumeq ̝ô ȖȖȖȖȖȖȖ η η Increased risk • #*4'2#%0 4'0 !- '!'12 2ô̜1RPG@GJB̝ ÓNWXBNCNMD η X NEÓQDM@KÓSNWHBHSXÓHEÓ Ȗ Ȗ tramadol Ȗ hydrocodone ÓEDMS@MXK BNLAHMDCÓVHSGÓ2SQHAHKCÓ SDMNENUHQÓDȎDBS

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01ơ̂.'̜

0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R X @MMQRCBô.'Q ôC E η ÓEDMS@MXK ÓRGNTKCÓMNSÓADÓTRDCÓ • 2 8 , 4'0 (Evotaz, Reyataz) ÓNWXBNCNMD η VHSGÓ"8/ ÓHMGHAHSNQRÓTMKDRRÓSGDÓ Ȗ Ȗ tramadol ȖȖ • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô hydrocodone patient is very closely monitored @MCÓÓ@ÓQDCTBSHNMÓHMÓEDMS@MXKÓCNRDÓ • *-.', 4'0 (Kaletra) HRÓNȓDMÓQDPTHQDC , 0!-2'!1 ,-,̝, 0!-2'!ô , *%#1'!1 ,NQOGHMD .SGDQÓ MSH (MȐ@LL@SNQXÓ "NCDHMD Acetaminophen Hydromorphone ,DCHB@SHNMRÓ-2 (#2 .WXBNCNMDÓ/DQBNBDSt ,DSG@CNMD 3Q@L@CNK %DMS@MXK 3XKDMNKÓ #HK@TCHCt $ F Ó KDUD Ó CUHK Ó,NSQHM 'XCQNBNCNMDÓ'XBNC@Mt 2 Ó ROHQHM GDQNHMÓ@MCÓBNB@HMD 5NKS@QDM Ó"DKDAQDW ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01ơ̂,,02'̜ η /NSDMSH@KÓENQÓ η fôô#$ 4'0#,8ô̜ RPGNJ? ô1SQRGT?̝ η methadone and Increased risk fôô#20 4'0',#ô̜'LRCJCLAC̝ Ó.WXBNCNMD VHSGCQ@V@KÓ η η NEÓQDM@K Ȗ Ó3Q@L@CNK Ó%DMS@MXK Ȗ fôô,#4'0 .',#ô̜Viramune ̝ hydrocodone symptoms SNWHBHSXÓHEÓBNLAHMDCÓ DE@UHQDMY Ó VHSGÓ SQHOK@Ó MDUHQ@OHMD or Complera SDMNENUHQÓDȎDBS fô0'*.'4'0',#ô̜#BSP?LR ô!MKNJCP?̝ ȖȖȖȖȖȖ ,3!*#-2'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01ơ̂,02'̜

• 2#,-$-4'0ô"'1-.0-6'*ô4GPC?B ô η Increased risk 2PST?B? ô RPGNJ? ô1RPG@GJB ô!MKNJCP?ô ȖȖȖȖȖȖ NEÓQDM@KÓSNWHBHSX

•ô-RFCPô,02'Q ȖȖȖȖȖȖȖ

, *%#1'!1 , *%#1'!1ơ̂. ',ô)'**#01̜ +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

!-"#',#ô"#0'4 2'4#1ôô20 + "-*ô +-0.&',#ô"#0'4 2'4#1 +#2& "-,# ,1 '"1 ô$#,2 ,7*

"8/#Ó@MCÓ ÓLDS@ANKHRLÓ(MGHAHSHNM +#!& ,'1+ô-$ô',2#0 !2'-, ,NRSKXÓ4&3ÓLDS@ANKHYDCÓQDM@KÓDKHLHM@SHNM "8/ Ó@MCÓ#ÓLDS@ANKHRLÓHMCTBSHNM "NLAHMHMFÓMDOGQNSNWHBÓ@FDMSR "8/ Ó(MCTBSHNM

Cobicistat and Protease Inhibitors + ',ô',2#0 !2',%ô 04s None $E@UHQDMYÓ@MCÓ-DUHQ@OHMD 3DMNENUHQ BNMS@HMHMFÓQDFHLDMR --13(R

Possible increases in narcotic levels Possible decrease in methadone levels Consider alternative pain control MANAGEMENT** None ONSDMSH@KKXÓKD@CHMFÓSNÓVHSGCQ@V@KÓNQÓKNRRÓ Possible decrease in narcotic level NEÓO@HMÓBNMSQNK "NMRHCDQÓ@KSDQM@SHUDÓ 15ÓQDFHLDM

,NMHSNQÓENQÓHMBQD@RDÓNOHNHCÓRHCDÓDȎDBSRÓ RXLOSNLRÓNEÓNUDQCNRD 3GDÓ#TQ@FDRHBÓEDMS@MXKÓLNMNFQ@OGÓRS@SDRÓÓ ,NMHSNQÓENQÓRXLOSNLRÓNEÓNOH@SDÓVHSGCQ@V@KÓ b3GDÓBNMBNLHS@MSÓTRDÓNEÓ"8/ ÓHMGHAHSNQRÓ@MCÓ ,NMHSNQÓ1DM@KÓETMBSHNM None or increase in pain and increase methadone +-,'2-0',% #41 &$2("Ó, 3ÓHRÓMNSÓQDBNLLDMCDC ÓTMKDRRÓ CNRDÓAXÓÓLFÓHMBQDLDMSR RRDRRÓ.3"Ó-2 (#ÓTRD the patient is closely monitored” ,NMHSNQÓO@HMÓRXLOSNLRÓ@MCÓ@CITRSÓM@QBNSHBÓ doses incrementally as needed

, *%#1'!1

,2'!-,43*1 ,21

GABAPENTIN .&#,72-', ̛,CSPMLRGL̜ 4 *.0- 2# ! 0 + 8#.',# !*- 8 + * +-20'%',# *#4#2'0 !#2 +ô ̛"GJ?LRGL̜ 2-.'0 + 2# ̛#NGT?J ô ̛2CEPCRMJ̜ ̛$PGQGSK̜ .0#% *', ̛*?KGAR?J̜ ̛)CNNP?̜ ô ̛2MN?K?V̜ "CN?ICLC̜ ̛*WPGA?̜ .&#,- 0 '2 * ',2#%0 1#ô',&' '2-01 η η Ó#3&Ó@MCÓ1 + Ó#3&Ó@MCÓ1 + • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ ȖȖȖȖ ȖȖ Ó#NKTSDFQ@UHQÓ Ó#NKTSDFQ@UHQÓ dose to 50 mg b.i.d. dose to 50 mg b.i.d.

• #*4'2#%0 4'0 !- '!'12 2ô X η X Potential ̜1RPG@GJB ô%CLTMW?̝ Ó$KUHSDFQ@UHQÓ ȖȖȖ Ó$KUHSDFQ@UHQÓ ȖȖ concentrations BKNA@Y@L concentrations

No guidelines No guidelines @U@HK@AKDÓENQÓ @U@HK@AKDÓENQÓ • 0 *2#%0 4'0ô̜'QCLRPCQQ̝ raltegravir dose ȖȖȖȖ raltegravir dose ȖȖ @CITRSLDMS @CITRSLDMS

,2'!-,43*1 ,2 ,2'!-,43*1 ,21

X •ôôôô!M@GAGQR?R @MMQRCBô.'Q PI η X 2 8 , 4'0 (Evotaz) concentrations, Potential ȖȖȖ PI ȖȖ " 03, 4'0ô.PCXAM@GV ÓB@QA@L@YDOHMDÓ BKNA@Y@L concentrations concentrations

η ÓB@QA@L@YDOHMDÓ X concentrations • 0'2-, 4'0ô̜,MPTGP @MMQRCBô.'Q η η PI η • 2 8 , 4'0 (Evotaz,Reyataz) potential PI Potential Ȗ lamotrigine Ȗ concentrations valproate concentrations • " 03, 4'0ô.PCXAM@GV ô.PCXGQR? BKNA@Y@L concentrations unpredictable or concentrations KNOHM@UHQ ÓC@HKXÓ in anticonvulsant • *-.', 4'0 (Kaletra) darunavir – b.i.d. levels C@QTM@UHQÓ.*

,2'!-,43*1 ,2 GABAPENTIN .&#,72-', ̛,CSPMLRGL̜ 4 *.0- 2# ! 0 + 8#.',# !*- 8 + * +-20'%',# *#4#2'0 !#2 +ô ̛"GJ?LRGL̜ 2-.'0 + 2# ̛#NGT?J ô ̛2CEPCRMJ̜ ̛$PGQGSK̜ .0#% *', ̛*?KGAR?J̜ ̛)CNNP?̜ ô ̛2MN?K?V̜ "CN?ICLC̜ ̛*WPGA?̜ .&#,- 0 '2 * ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01ơ̂,,02'̜ X • 0'*.'4'0',#ô̜!MKNJCP?, Edurant̝ Ó1HKOHUHQHMD ȖȖȖȖ X ȖȖ /GDMXSNHM Ó1HKOHUHQHMDÓ Phenobarbital

η η Ó"KNA@Y@L Potential $E@UHQDMY MDUHQ@OHMDÓ@MCNQÓ • η ô#$ 4'0#,8ô1SQRGT? ô RPGNJ? Nevirapine Potential anticonvulsants (Viramune) ,#4'0 .',# "KNA@Y@L Ȗ η Ȗ ȖȖ #20 4'0',#ô'LRCJCLAC X Ó$SQ@UHQHMD X Ó$SQ@UHQHMD Ó$E@UHQDMY ÓÓ "KNA@Y@L $SQ@UHQHMDÓ

,2'!-,43*1 ,2 ,2'!-,43*1 ,21 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLR ô?LBô+MLGRMPGLE

% .#,2', ô.0#% *', ! 0 + 8#.',# .&#,- 0 '2 * ô.&#,72-', * +-20'%',# ô4 *.0- 2# !*- 8 + 2-.'0 + 2# ô*#4#2'0 !#2 +

"8/ ÓRTARSQ@SDÓ@MCÓHMCTBDQÓ 2TARSQ@SDÓNEÓ" Ó"Ó@MCÓONSDMSÓ /QHL@QHKXÓBKD@QDCÓUH@Ó4&3 "8/ ÓRTARSQ@SD ÓÓ/NSDMSH@KÓENQÓ NEÓ"8/ Ó" Ó4&3 Ó/NSDMSH@KÓ HMCTBDQRÓNEÓ"8/ Ó" Ó4&3 ÓÓ HMBQD@RDCÓBKNA@Y@LÓVHSGÓANNRSDCÓ /QHL@QHKXÓDWBQDSDCÓTMBG@MFDCÓHMÓTQHMD +@LNSQHFHMDÓLHKCÓ4&3ÓHMCTBDQ +#!& ,'1+ô-$ô',2#0 !2'-, ENQÓCDBQD@RDCÓ@MSHQDSQNUHQ@KRÓNQÓ /NSDMSH@KÓENQÓCDBQD@RDCÓ@MSHQDSQNUHQ@KRÓ regimens and decreased HMBQD@RDCÓB@QA@L@YDOHMD or decreased anticonvulsants 5@KOQN@SDÓ(MGHAHSNQÓNEÓ4&3 Ó"8/" BNMBDMSQ@SHNMRÓVHSGÓ--13(R

1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ /NSDMSH@KÓENQÓCDBQD@RDCÓ 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ protease inhibitors or elvitegravir, anticonvulsants due protease inhibitors or elvitegravir, None protease inhibitors or elvitegravir, + ',ô',2#0 !2',%ô 04s dolutegravir, raltegravir, rilpivirine, SNÓ4&3ÓHMCTBSHNMÓAXÓQHSNM@UHQ ANNRSDCÓ dolutegravir, raltegravir, rilpivirine ,NRSÓ--13(RÓ DE@UHQDMY /(RÓ@MCÓDE@UHQDMY DE@UHQDMY ÓDSQ@UHQHMD ÓMDUHQ@OHMD

UNHCÓVHSGÓBNAHBHRS@S ANNRSDCÓ/(R Ó QHKOHUHQHMD Ó@MCÓDKUHSDFQ@UHQBNAHBHRS@S ÓÓ UNHCÓSGDRDÓ@MSHBNMUTKR@MSRÓHEÓNSGDQRÓ ,@XÓG@UDÓSNÓHMBQD@RDÓCNRDÓNEÓ !NNRSDCÓQDFHLDMRÓL@XÓHMBQD@RDÓ ,@XÓMDDCÓSNÓQDCTBDÓB@QA@L@YDOHMDÓ @QDÓ@U@HK@AKDÓ@MCÓDȑB@BHNTR @MSHBNMUTKR@MSÓHEÓ 15ÓQDFHLDMÓB@MMNSÓ None BKNA@Y@LÓ@MCÓQHRJÓNEÓSNWHBHSX Ó MANAGEMENT CNRDÓVHSGÓQHSNM@UHQ ANNRSDCÓ/(R ADÓBG@MFDCÓ@MCNQÓHEÓSGDQDÓHRÓMNÓNSGDQÓ (MBQD@RDÓCNKTSDFQ@UHQÓSNÓÓLFÓA H C Ó --13(RÓL@XÓCDBQD@RDÓBKNA@Y@L (MBQD@RDÓCNKTSDFQ@UHQÓSNÓÓLFÓA H C Ó TRDÓQ@KSDFQ@UHQÓVHSGÓB@TSHNM suitable anticonvulsant TRDÓQ@KSDFQ@UHQÓVHSGÓB@TSHNM

MSHQDSQNUHQ@KÓDȑB@BX MSHQDSQNUHQ@KÓDȑB@BX ,NMHSNQÓENQÓRHFMRÓNEÓSNWHBHSXÓ@MCÓ +-,'2-0',% None "@QA@L@YDOHMDÓBNMBDMSQ@SHNMRÓ@MCÓ Ó,NMHSNQÓENQÓ"!9ÓSNWHBHSX Ó ,NMHSNQÓENQÓKNRRÓNEÓRDHYTQDÓBNMSQNK QDCTBDÓCNRDÓHEÓMDBDRR@QX SNWHBHSXÓRNLMNKDMBD CHYYHMDRR KNRRÓNEÓRDHYTQDÓBNMSQNK ,NMHSNQÓENQÓKNRRÓNEÓRDHYTQDÓBNMSQNK

,2'!-,43*1 ,2

&#. 2'2'1ô!ô20# 2+#,2

"'0#!2̝ !2',%ô %#,21 -*"#0ô20# 2+#,21 .LAHS@RUHQÓ/@QHS@OQDUHQQ Pegylated +DCHO@RUHQÓ Ó2NENRATUHQ 2NENRATUHQ #@R@ATUHQ #@BK@S@RUHQÓ#@JKHMY@ (MSDQEDQNMÓ 1HA@UHQHM '@QUNMH 2NU@KCH 'NKJHQ@ Ó3DBGMHUHD alpha 2a ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ ȖȖȖȖȖȖ η X /NSDMSH@KÓ • #*4'2#%0 4'0 !- '!'12 2ô η /NSDMSH@KÓ Potential increase ̜1RPG@GJB ô%CLWMT?̝ Ȗ Ó#@BK@S@RUHQÓ ȖȖ Ó3DMNENUHQ in elvitegravir or 1DCTBDÓCNRDÓ paritaprevir SNÓÓLFÓC@HKXÓ • 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01ơ̂.'̜ η Ó#@BK@S@RUHQÓVHSGÓ 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R ANNRSDCÓ@S@Y@M@UHQ X Ó1DCTBDÓCNRDÓSNÓ @MMQRCBô.'Q ôC E η .JÓVHSGÓ 35ÓÓLFÓ@MCÓ ÓLFÓC@HKXÓ • 2 8 , 4'0 (Evotaz, Reyataz) /NSDMSH@KÓ ONRRHAKXÓTMANNRSDCÓ#15Ó Ȗ ȖȖ • " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô Ó3DMNENUHQ ATSÓ3#,ÓNEÓ 15ÓKDUDKRÓ • *-.', 4'0 (Kaletra) highly suggested Ȗ C@QTM@UHQ ÓKNOHM@UHQ

&#. 2'2'1ô!ô 20# 2+#,2 &#. 2'2'1ô!ô20# 2+#,2

"'0#!2̝ !2',%ô %#,21 -*"#0ô20# 2+#,21 .LAHS@RUHQÓ/@QHS@OQDUHQQ Pegylated +DCHO@RUHQÓ Ó2NENRATUHQ 2NENRATUHQ #@R@ATUHQ #@BK@S@RUHQÓ#@JKHMY@ (MSDQEDQNMÓ 1HA@UHQHM '@QUNMH 2NU@KCH 'NKJHQ@ Ó3DBGMHUHD alpha 2a ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01ơ̂,,02'̜ η • #$ 4'0#,8ô̜ RPGNJ? ô1SQRGT? Ó#@BK@S@RUHQ Increase dose to 90 mg η daily Ó3DMNENUHQ X Ȗ ȖȖ VGDMÓTRHMFÓ SQHOK@ X • #20 4'0',#ô̜'LRCJCLAC̝ $SQ@UHQHMDÓ@MCÓ • ,#4'0 .',#ô̜ Viramune ̝ nevirapine #@BK@S@RUHQÓ+DUDKRÓ

X η Ó1HKOHUHQHMDÓ • 0'*.'4'0',#ô̜#BSP?LR ô!MKNJCP?̝ Ó3DMNENUHQÓ ȖȖȖȖ VGDMÓTRHMFÓ"NLOKDQ@ /NSDMSH@KÓ03Ó prolongation

&#. 2'2'1ô!ô 20# 2+#,2 "'0#!2̝ !2',%ô %#,21 -*"#0ô20# 2+#,21 .LAHS@RUHQÓ/@QHS@OQDUHQQ Pegylated +DCHO@RUHQÓ Ó2NENRATUHQ 2NENRATUHQ #@R@ATUHQ #@BK@S@RUHQÓ#@JKHMY@ (MSDQEDQNMÓ 1HA@UHQHM '@QUNMH 2NU@KCH 'NKJHQ@ Ó3DBGMHUHD alpha 2a ,3!*#-2'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01ơ̂,02'̜ • 2#,-$-4'0ô"'1-.0-6'*ô̜ Viread, η 2PST?B? ô RPGNJ? ô1RPG@GJB ô!MKNJCP?ô Ó3DMNENUHQ ȖȖȖȖȖ • -2�ô,02' s C E ô ! 4'0ô̜8G?ECLôMPô)GTCV?̝ ô Ȗ * +'43"',# ô#+20'!'2 ',# ȖȖȖȖ A@B@UHQÓ@MCÓ3DMNENUHQÓ@MCÓ%3"Ó@MCÓ3"ÓNJ 8'"-43"',#ô̜0CRPMTGP ô!MK@GTGP̝ X 9HCNUTCHMD • 8'"-43"',#ô̜0CRPMTGP ô!MK@GTGP̝ ȖȖȖȖ #HC@MNRHMD 2S@UTCHMD

&#. 2'2'1ô!ô 20# 2+#,2 &#. 2'2'1ô!ô20# 2+#,2 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

-+ '2 14'0 . 0'2 .0#4'0 0 *#"'. 14'0ô ô1-$-1 34'0 .#%7* 2#" ̝" 1 34'0 " !* 2 14'0ơ̂" )*',8 ̜ INTERFERON ̛& 04-,'̜ ̛&-*)'0 ô. )̜ơ̂2#!&,'4'#̜ *.& ô ôô0' 4'0',

1HSNM@UHQÓANNRSÓ@KQD@CXÓOQDRDMS +DCHO@RUHQÓHRÓ@ÓLHKCÓHMGHAHSNQÓNEÓ/F/ Ó!"1/ Ó +#!& ,'1+ô-$ô',2#0 !2'-, "NLAHM@SHNMRÓVHSGÓ"8/ Ó/F/ÓHMGHAHSNQRÓ 2TARSQ@SDÓNEÓ/ FKXBNOQNSDHMÓ@MCÓ"8/ . 3/!Ó@MCÓ. 3/! @MCÓHMCTBDQRÓVHKKÓKD@CÓSNÓTMOQDCHBS@AKDÓ CQTFÓKDUDKRÓENQÓ@KK

!NNRSDCÓ/(R ÓDKUHSDFQ@UHQBNAHBHRS@SÓ@MCÓ--13(RÓ PIs, Cobicistat VGDMÓBNLAHMDCÓVHSGÓSDMNENUHQ "NMSQ@HMCHB@SDCÓVHSGÓYHCNUTCHMDÓCTDÓSNÓ + ',ô',2#0 !2',%ô 04s $E@UHQDMYÓ-DUHQ@OHMD PIs (MBQD@RDCÓSDMNENUHQÓKDUDKRÓB@MÓONSDMSH@KKXÓKD@CÓ HMBQD@RDCÓSNWHBHSX 1HKOHUHQHMD SNÓQDM@KÓSNWHBHSX --13(R

UNHCÓVHSGÓ@KKÓANNRSDCÓ/(RÓNQÓHMSDFQ@RDÓ (EÓOQD DWHRSHMFÓQDM@KÓBNLOQNLHRD Ó HMGHAHSNQRÓANNRSDCÓVHSGÓQHSNM@UHQÓNQÓBNAHBHRS@S ÓÓ CITRSÓC@BK@S@RUHQÓCNRDÓ@BBNQCHMFKX ÓÓ BNMRHCDQÓRVHSBGHMFÓSNÓMNM SDMNENUHQÓ UNHCÓVHSGÓ@KKÓ--13(R !DRSÓBNLAHMDCÓVHSGÓCNKTSDFQ@UHQ ÓQ@KSDFQ@UHQ Ó MANAGEMENT** A@BJANMDÓNQÓQDFHLDM Ó.SGDQVHRD Ó NQÓQHKOHUHQHMD A@RDCÓQDFHLDMR LNMHSNQÓQDM@KÓETMBSHNMÓBKNRDKX !DRSÓSNÓBNLAHMDÓVHSGÓCNKTSDFQ@UHQÓ or raltegravir based regimens

&#. 2'2'1ô!ô 20# 2+#,2 -+ '2 14'0 . 0'2 .0#4'0 0 *#"'. 14'0ô ô1-$-1 34'0 .#%7* 2#" ̝" 1 34'0 " !* 2 14'0ơ̂" )*',8 ̜ INTERFERON ̛& 04-,'̜ ̛&-*)'0 ô. )̜ơ̂2#!&,'4'#̜ *.& ô ôô0' 4'0',

,NMHSNQÓQDM@KÓETMBSHNMÓ VGDMÓTRDCÓÓVHSGÓSDMNENUHQ (EÓ@CCHMFÓTMANNRSDCÓ@S@Y@M@UHQÓNQÓC@QTM@UHQ Ó +-,'2-0',% D&%1 ÓRDQTLÓBQD@SHMHMDÓ@MCÓOGNROG@SDÓ suggest measuring antiretroviral concentrations TQHMDÓBQD@SHMHMDÓ@MCÓOGNROG@SDÓHEÓ@RRDRRHMFÓ tubular damage

,-2#1

&#. 2'2'1ô!ô 20# 2+#,2 "' #2#1ô+#"'! 2'-,1 ,2'&7.#0%*7!#+'!ô"03%1

ô%*3!-1'" 1#ô &3+ ,ô%*3! %-,̝*')#ô.#.2'"# '%3 ,'"#1 "..̝ô',&' '2-01 ',&' '2-01 ̛%*.̝ô %-,'121̜

• "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ η Ȗ Ó,DSENQLHM ȖȖȖȖȖ

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01

• " 03, 4'0ô̜.PCXAM@GV ô.PCXGQR?̝ô η ȖȖȖȖȖȖ /NSDMSH@KÓENQÓ@CCHSHUDÓ • *-.', 4'0ô̜ Kaletra̝ /1ÓOQNKNMF@SHNM

"' #2#1ô +#"'! 2'-,1 ô%*3!-1'" 1#ô &3+ ,ô%*3! %-,̝*')#ô.#.2'"# '%3 ,'"#1 "..̝ô',&' '2-01 ',&' '2-01 ̛%*.̝ô %-,'121̜

2HS@FKHOSHMÓ ,DSENQLHM 2@W@FKHOSHMÓ.MFKXY@ Acarbose )@MTUH@Ó &KTBNOG@FD Ó&KTLDSY@ Ó +HM@FKHOSHMÓ3Q@IDMS@ $WDM@SHCDÓÓ!XDSS@ +HQ@FKTSHCDÓ5HBSNY@ /Q@MC@RD Ó&KTBNA@X 2@W@FKHOSHMLDSENQLHMÓ 2HS@FKHOSHMLDSENQLHM U@MC@LDS Ó)@MTLDS *NLAHFKXYD )@MTLDS ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 η fôô0'*.'4'0',#ô̜!MKNJCP? ô#BSP?LR̝ ȖȖȖȖȖȖ /NSDMSH@KÓENQÓ@CCHSHUDÓ /1ÓOQNKNMF@SHNM fô#$ 4'0#,8ô1SQRGT? ô RPGNJ? η η fô#20 4'0',#ô̜'LRCJCLAC̝ ȖȖ /NSDMSH@KÓENQÓ Potential ȖȖȖ fô,#4'0 .',#ô̜Viramune ̝ linagliptin R@W@FKHOSHM

"' #2#1ô +#"'! 2'-,1 "' #2#1ô+#"'! 2'-,1 ,2'&7.#0%*7!#+'!ô"03%1

+#%*'2','"#1 1%*2ô',&' '2-01 13*$-,7*30# 1ô 2&' 8-*'"',#"'-,#1ơ̂28"1̜

1NRHFKHS@YNMD &KHBK@YHCDÓ#H@LHBQNM 1DO@FKHMHCD Nateglinide "@M@FKHȐNYHM #@O@FKHȐNYHMÓ%NQWHF@ Ó /HNFKHS@YNMD U@MCH@ &KHLDOHQHCDÓ L@QXK &KTBN-NQL 2S@QKHW (MUNJ@M@ DLO@FKHȐNYHMÓ)@QCH@MBDÓ BSNR 1NRHFKHS@YNMD,DSENQLHM &KXATQHCDÓ#H@ADS@ U@MC@LDS ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ ȖȖȖȖȖȖȖ

• #*4'2#%0 4'0 ô!- '!'12 2ô η η η Potential Potential Potential ̜1RPG@GJB ô%CLTMW?̝ ȖȖ ȖȖ repaglinide nateglinide ÓRTKENMXTQD@Ó • 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 η η η Potential Potential Potential η Potential ÓQNRHFKHS@YNMDÓVHSGÓ • 0'2-, 4'0ô̜ Norvir̝ô or ÓB@M@FKHȐNYHMÓVHSGÓ ÓRTKENMXTQD@ÓVHSGÓ OHNFKHS@YNMD @S@Y@M@UHQÓ@KNMDÓ AM@GAGQR?R @MMQRCB .'Q ôC E η QHSNM@UHQ ANNRSDCÓ/(R QHSNM@UHQ ANNRSDCÓ/(R η VHSGÓ"ÓHMGHAHSHNM • 2 8 , 4'0ô̜ Reyataz ̝ Potential Potential Ȗ nateglinide • " 03, 4'0ô̜.PCXAM@GV ô.PCXGQR?ô repaglinide concentrations Ȗ Ȗ • *-.', 4'0ô̜Kaletra̝ "NAHBHRS@S ANNRSDCÓ "NAHBHRS@S ANNRSDCÓ /(RÓMNÓHMSDQ@BSHNMÓ /(RÓMNÓHMSDQ@BSHNMÓ ȖȖ DWODBSDC DWODBSDC

"' #2#1ô +#"'! 2'-,1 +#%*'2','"#1 1%*2ô',&' '2-01 13*$-,7*30# 1ô 2&' 8-*'"',#"'-,#1ơ̂28"1̜

1NRHFKHS@YNMD &KHBK@YHCDÓ#H@LHBQNM 1DO@FKHMHCD Nateglinide "@M@FKHȐNYHM #@O@FKHȐNYHMÓ%NQWHF@ Ó /HNFKHS@YNMD U@MCH@ &KHLDOHQHCDÓ L@QXK &KTBN-NQL 2S@QKHW (MUNJ@M@ DLO@FKHȐNYHMÓ)@QCH@MBDÓ BSNR 1NRHFKHS@YNMD,DSENQLHM &KXATQHCDÓ#H@ADS@ U@MC@LDS ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 fôô0'*.'4'0',#ô̜!MKNJCP? ô#BSP?LR̝ ȖȖȖȖȖȖȖ

η η fô#$ 4'0#,8ô1SQRGT? ô RPGNJ? Potential η Potential η Potential η fô#20 4'0',#ô̜'LRCJCLAC̝ Potential M@SDFKHMHCDÓVHSGÓ RTKENMXTQD@ÓVHSGÓ Potential B@M@FKHȐNYHMÓVHSGÓ Ȗ Ȗ fô,#4'0 .',#ô̜Viramune ̝ repaglinide etravirine and etravirine and OHNFKHS@YNMD DE@UHQDMY DE@UHQDMY DE@UHQDMY

"' #2#1ô +#"'! 2'-,1 "' #2#1ô+#"'! 2'-,1 ,2'&7.#0%*7!#+'!ô"03%1 +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

+#2$-0+', "..̝ô',&' '2-01 +#%*'2','"#1 +CRDMPKGL DWBQDSDCÓϾÓ as unchanged drug *GL?EJGNRGLô 0CN?EJGLGBCô *GL?EJGNRGL ôQ?V?EJGNRGL ,?RCEJGLGBC induction ,?RCEJGLGBC inhibition +#!& ,'1+ô-$ô AXÓFKNLDQTK@QÓȏKSQ@SHNMÓ HMGHAHSHNMÓNEÓ"8/ Ó@MCÓ/ FO HMGHAHSHNMÓ. 3/!Ó@MCÓ ',2#0 !2'-, HMCTBSHNMÓNEÓ"8/ / FO "8/" "8/" plus active tubular secretion 1?V?EJGNRGLÓHMGHAHSHNMÓNEÓ"8/ ÓÓ "8/ UH@Ó."3Ó@MCÓ , 3$ * 1HSNM@UHQÓ@MCÓBNAHBHRS@S + ',ô 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ boosted protease inhibitors #NKTSDFQ@UHQ protease inhibitors and $E@UHQDMY ÓDSQ@UHQHMD ÓMDUHQ@OHMD $KUHSDFQ@UHQ $E@UHQDMY ÓDSQ@UHQHMD ',2#0 !2',%ô @MCÓBNAHBHRS@S ANNRSDCÓ BNAHBHRS@S ANNRSDCÓDKUHSDFQ@UHQ ARVs elvitegravir "KNRDÓLNMHSNQHMFÓHRÓQDBNLLDMCDCÓVGDMÓRS@QSHMFÓ NQÓRSNOOHMFÓCNKTSDFQ@UHQÓ@MCÓLDSENQLHMÓSNFDSGDQ (EÓO@SHDMSÓHRÓ@KQD@CXÓQDBDHUHMFÓCNKTSDFQ@UHQ ÓRS@QSÓVHSGÓ@Ó KNVÓLDSENQLHMÓCNRDÓ@MCÓFQ@CT@KKXÓHMBQD@RD Ó(EÓO@SHDMSÓ ,@XÓMNSÓADÓBKHMHB@KKXÓRHFMHȏB@MS Ó HRÓRS@QSHMFRSNOHMFÓCNKTSDFQ@UHQÓVGHKDÓQDBDHUHMFÓ RHMBDÓKHM@FKHOSHMÓ@MCÓR@W@FKHOSHMÓ CITRSÓKHM@FKHOSHMÓ@MCÓ CITRSÓCNRDÓHEÓMDDCDC CITRSÓCNRDÓHEÓMDDCDC CITRSÓCNRDÓHEÓMDDCDC MANAGEMENT LDSENQLHM Ó@ÓCNRDÓ@CITRSLDMSÓL@XÓADÓMDBDRR@QX G@UDÓ@ÓK@QFDÓR@EDSXÓVHMCNV R@W@FKHOSHMÓCNRDRÓHEÓMDDCDC Choose an alternative antidiabetic agent or -NÓCNRDÓ@CITRSLDMSÓMDBDRR@QX @MSHQDSQNUHQ@KÓHEÓGHFG CNRDÓLDSENQLHMÓHRÓMNSÓ SNKDQ@SDCÓVHSGÓCNKTSDFQ@UHQ ÓHEÓHSÓHRÓBNMRHCDQDCÓ necessary "KNRDÓLNMHSNQHMFÓNEÓRHCDÓ ,DSENQLHMÓRHCDÓDȎDBSRÓ "KNRDÓLNMHSNQHMFÓNEÓ No monitoring suggested "KNRDÓLNMHSNQHMFÓNEÓDȑB@BX MSHGXODQFKXBDLHBÓDȑB@BX DȎDBSR Ó,@XÓONSDMSH@SDÓSGDÓ +-,'2-0',% OQHL@QHKXÓF@RSQNHMSDRSHM@K RHCDÓDȎDBSR hypoglycemic action

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1%*2ô',&' '2-01 13*$-,7*30# 1 2&' 8-*'"',#"'-,#1

+#!& ,'1+ô-$ô %JGAJ?XGBC ôEJGKCNGPGBCô?LBô %JGAJ?XGBC ôEJGKCNGPGBCô?LBô .GMEJGR?XMLCô .GMEJGR?XMLC !?L?EJGǬMXGLÓHMCTBSHNMÓ4&3 0MQGEJGR?XMLCô "ÓHMGHAHSHNM ',2#0 !2'-, EJW@SPGBC 2C9 induction EJW@SPGBC 2C9 inhibition ÓHMGHAHSHNM Ó ÓHMCTBSHNM

+ ',ô 1HSNM@UHQÓ@MCÓBNAHBHRS@SÓ 1HSNM@UHQÓOQNSD@RDÓHMGHAHSNQRÓ 1HSNM@UHQÓ/(RÓANNRSDC $E@UHQDMY ÓMDUHQ@OHMDÓ ',2#0 !2',%ô $E@UHQDMYÓ@MCÓDSQ@UHQHMD PIs boosted 4MANNRSDCÓ@S@Y@M@UHQ ANNRSDCÓ@MCÓDE@UHQDMY $KUHSDFQ@UHQ and etravirine ARVs Cobicistat elvitegravir boosted

MANAGEMENT CITRSÓCNRDÓ@RÓMDDCDC CITRSÓCNRDÓ@RÓMDDCDC CITRSÓCNRDÓ@RÓMDDCDC CITRSÓCNRDÓ@RÓMDDCDC CITRSÓCNRDÓ@RÓMDDCDC CITRSÓCNRDÓ@RÓMDDCDC

+-,'2-0',% MSHGXODQFKXBDLHBÓDȑB@BX MSHGXODQFKXBDLHBÓDȑB@BX 2TKENMXKTQD@ÓRHCDÓDȎDBSRÓ /HNFKHS@YNMDÓRHCDÓDȎDBSR MSHGXODQFKXBDLHBÓDȑB@BX 1NRHFKHS@YNMDÓRHCDÓDȎDBSR

"' #2#1ô +#"'! 2'-,1 !-02'!-12#0-'"ô',2#0 !2'-,1ô ̛',& *#" ô',20 , 1 * ô',(#!2 *#̜

',20 , 1 *ô-0ô-0 *ô',& * 2'-, ',(#!2 *#

!DBKNLDSG@RNMD !TCDRNMHCD %KTSHB@RNMD ,NLDS@RNMD Ciclesonide 0U@Q /TKLHBNQS2XLAHBNQS %KNUDMS CU@HQ RL@MDW9DMG@KD 3QH@LBHMNKNMD KUDRBN !DBNM@RD 1GHMNBNQS %KNM@RD U@LXR -@RNMDW ',2#%0 1#ô',&' '2-01 • "-*32#%0 4'0ô̜ Tivicay, Triumeq ̝ Ȗ Ȗ η Potential systemic X η Potential systemic η Potential systemic budesonide and risk η Potential systemic • #*4'2#%0 4'0 !- '!'12 2ô Potential ciclesonide. ȐTSHB@RNMDÓ@MCÓQHRJÓ triamcinolone and NEÓ"TRGHMFRÓRXMCQNLDÓ LNLDS@RNMDÓ@MCÓQHRJÓNEÓÓ ̜1RPG@GJB ô%CLTMW?̝ Ȗ ,@XÓADÓTRDCÓVHSGÓ NEÓÓ"TRGHMFRÓRXMCQNLDÓ QHRJÓNEÓ"TRGHMFRÓ @MCÓ@CQDM@KÓE@HKTQD "TRGHMFRÓRXMCQNLDÓ@MCÓ monitoring @MCÓ@CQDM@KÓE@HKTQD syndrome and @CQDM@KÓE@HKTQD 2DDÓL@M@FDLDMSÓ @CQDM@KÓE@HKTQD and monitoring Avoid combination

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ Ȗ Ȗ

!-02'!-12#0-'"ô ',2#0 !2'-,1ô ',20 , 1 *ô-0ô-0 *ô',& * 2'-, ',(#!2 *#

!DBKNLDSG@RNMD !TCDRNMHCD %KTSHB@RNMD ,NLDS@RNMD Ciclesonide 0U@Q /TKLHBNQS2XLAHBNQS %KNUDMS CU@HQ RL@MDW9DMG@KD 3QH@LBHMNKNMD KUDRBN !DBNM@RD 1GHMNBNQS %KNM@RD U@LXR -@RNMDW .0-2# 1#ô',&' '2-01 η 0'2-, 4'0ô,MPTGPôMPôAM@GAGQR?R Potential systemic X η Potential systemic η Potential systemic @MMQRCBô.'Q ôC E budesonide and risk η Potential systemic Potential increased ȐTSHB@RNMDÓ@MCÓQHRJÓ triamcinolone and • 2 8 , 4'0 (Evotaz, Reyataz) NEÓ"TRGHMFRÓRXMCQNLDÓ LNLDS@RNMDÓ@MCÓQHRJÓNEÓÓ Ȗ BHBKDRNMHCD Ó,@XÓADÓTRDCÓ NEÓ"TRGHMFRÓRXMCQNLDÓ QHRJÓNEÓ"TRGHMFRÓ • @MCÓ@CQDM@KÓE@HKTQD "TRGHMFRÓRXMCQNLDÓ@MCÓ " 03, 4'0ô.PCXAM@GV ô.PCXGQR?ô VHSGÓLNMHSNQHMF @MCÓ@CQDM@KÓE@HKTQD syndrome and @CQDM@KÓE@HKTQD • *-.', 4'0 (Kaletra) 2DDÓL@M@FDLDMSÓ @CQDM@KÓE@HKTQD and monitoring Avoid combination. ,-,̝,3!*#-1'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 fô#$ 4'0#,8ô̜ RPGNJ? ô1SQRGT?̝ fô#20 4'0',#ô̜'LRCJCLAC̝ Ȗ Ȗ fô0'*.'4'0',#ô̜!MKNJCP?̝ fô,#4'0 .',#ô̜Viramune ̝

!-02'!-12#0-'"ô ',2#0 !2'-,1ô !-02'!-12#0-'"ô',2#0 !2'-,1ô ̛',& *#" ô',20 , 1 * ô',(#!2 *#̜ +CAF?LGQKôMDô"PSEô'LRCP?ARGMLQ ô+?L?ECKCLRô?LBô+MLGRMPGLE

3"#1-,'"#ô$*32'! 1-,# ô+-+#2 1-,#ô !'!*#1-,'"#ơ̂',& *#"̜ 20' +!',-*-,# ̛',& *#"ô-0ô',20 , 1 *̜ ',(#!2'-,

(MGHAHSHNMÓ"8/ ÓNEÓSGDÓ@BSHUDÓLDS@ANKHSDÓNEÓSGDÓBHBKDRNMHCD Ó (MGHAHSHNMÓNEÓ"8/ Ó (MGHAHSHNMÓNEÓ"8/ +#!& ,'1+ô-$ô',2#0 !2'-, /NSDMSH@KÓATSÓCNDRÓMNSÓRDDLÓSNÓADÓBKHMHB@KKXÓRHFMHȏB@MS

/QNSD@RDÓHMGHAHSNQRÓ/(ÓVHSGÓQHSNM@UHQÓNQÓBNAHBHRS@S Ó /QNSD@RDÓHMGHAHSNQRÓ/(ÓVHSGÓQHSNM@UHQÓNQÓBNAHBHRS@S Ó /QNSD@RDÓHMGHAHSNQRÓ/(ÓVHSGÓQHSNM@UHQÓNQÓBNAHBHRS@S Ó + ',ô',2#0 !2',%ô 04s DKUHSDFQ@UHQBNAHBHRS@SÓ2SQHAHKC DKUHSDFQ@UHQBNAHBHRS@SÓ2SQHAHKC DKUHSDFQ@UHQBNAHBHRS@SÓ2SQHAHKC

"TRGHMFRÓRXMCQNLDÓ@MCÓ@CQDM@KÓRTOOQDRRHNMÓG@UDÓADDMÓ QDONQSDCÓ@ȓDQÓDUDMÓRHMFKDÓHMIDBSHNMRÓNEÓSQH@LBHMNKNMD Ó3GDQDÓHRÓ /QDEDQÓADBKNLDSG@RNMDÓVGHBGÓCNDRÓMNSÓHMSDQ@BSÓ HMRTȑBHDMSÓHMENQL@SHNMÓSNÓHMCHB@SDÓVGDSGDQÓNSGDQÓHMIDBS@AKDÓ 4RDÓVHSGÓB@TSHNM MANAGEMENT ADB@TRDÓHSÓHRÓMNSÓLDS@ANKHYDCÓAXÓ"8/ RSDQNHCRÓOQDRDMSÓ@ÓKNVDQÓQHRJ Ó"NMRHCDQÓTRDÓNEÓ@MÓ@KSDQM@SDÓ @MSH HMȐ@LL@SNQXÓ@FDMSÓNQÓLNCHEXÓSNÓ@ÓMNM HMSDQ@BSHMFÓ @MSHQDSQNUHQ@KÓQDFHLDMÓHEÓONRRHAKD

,NMHSNQÓENQÓRXLOSNLRÓNEÓÓ"TRGHMFRÓRXMCQNLDÓLNNMÓE@BD Ó ,NMHSNQÓENQÓRXLOSNLRÓNEÓÓ"TRGHMFRÓRXMCQNLDÓLNNMÓE@BD Ó ,NMHSNQÓENQÓRXLOSNLRÓNEÓÓ"TRGHMFRÓRXMCQNLDÓLNNMÓE@BD Ó ATȎ@KNÓGTLO ÓNADRHSX ÓRSQH@SHNMR Ó@BMD ÓGHQRTSHRL ÓGXODQSDMRHNM Ó ATȎ@KNÓGTLO ÓNADRHSX ÓRSQH@SHNMR Ó@BMD ÓGHQRTSHRL ÓGXODQSDMRHNM Ó ATȎ@KNÓGTLO ÓNADRHSX ÓRSQH@SHNMR Ó@BMD ÓGHQRTSHRL ÓGXODQSDMRHNM Ó +-,'2-0',% NRSDNONQNRHR ÓFKTBNRDÓHMSNKDQ@MBD ÓHMBQD@RDCÓQHRJÓNEÓHMEDBSHNMR NRSDNONQNRHR ÓFKTBNRDÓHMSNKDQ@MBD ÓHMBQD@RDCÓQHRJÓNEÓHMEDBSHNMR NRSDNONQNRHR ÓFKTBNRDÓHMSNKDQ@MBD ÓHMBQD@RDCÓQHRJÓNEÓHMEDBSHNMR /K@RL@ÓBNQSHRNKÓ@MCÓ "3'ÓBNTKCÓADÓCNMDÓ /K@RL@ÓBNQSHRNKÓ@MCÓ "3'ÓBNTKCÓADÓCNMDÓ /K@RL@ÓBNQSHRNKÓ@MCÓ "3'ÓBNTKCÓADÓCNMDÓ HEÓ@CQDM@KÓRTOOQDRRHNMÓHRÓRTRODBSDC HEÓ@CQDM@KÓRTOOQDRRHNMÓHRÓRTRODBSDC HEÓ@CQDM@KÓRTOOQDRRHNMÓHRÓRTRODBSDC

!-02'!-12#0-'"ô ',2#0 !2'-,1ô

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• #$ 4'0#,8ô̜1SQRGT? ô RPGNJ?̝ η η • #20 4'0',#ô̜'LRCJCLAC̝ Cyclophosphamide η Antineoplastic and ȖȖ Ȗ ÓÓ#DW@LDSG@RNMD Ȗ • ,#4'0 .',#ô̜Viramune ̝ MDTQNSNWHBÓLDS@ANKHSD BXSNSNWHBÓOQNODQSHDR ,3!*#-2'"#ô0#4#01#ô20 ,1!0'.2 1#ô',&' '2-01 • 2#,-$-4'0ô"'1-.0-6'* 4GPC?B ô2PST?B? ô RPGNJ? ô η Ȗ ÓÓ1DM@KÓSNWHBHSX ȖȖȖȖȖ !MKNJCP? ô1RPG@GJB

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• #*4'2#%0 4'0 !- '!'12 2ô η η η η Vinca alkaloid and risk ̜1RPG@GJB ô%CLTMW?̝ Ó$SNONRHCD Ó(ENROG@LHCDÓ@BSHU@SHNM Ȗ Ó2SDQNHC Ȗ NEÓSNWHBHSX

• 0 *2#%0 4'0ô̜'QCLRPCQQ̝ ȖȖȖȖȖȖ .0-2# 1#ô',&' '2-01 0'2-, 4'0ô̜ Norvir̝ or AM@GAGQR?R @MMQRCB .'Q ôC E η • 2 8 , 4'0ô̜ Reyataz ̝ Possible active η η η η Vinca alkaloid and risk Ó$SNONRHCD Ó(ENROG@LHCDÓ@BSHU@SHNM Ȗ Ó2SDQNHC metabolite • " 03, 4'0ô̜.PCXAM@GV ô NEÓSNWHBHSX .PCXGQR?̝ô VHSGÓQHSNM@UHQÓANNRSDCÓ/(R • *-.', 4'0ô̜ Kaletra̝

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+#*.& * , ô+#1, ô +#2&7*.0#",'1-*-,# ô PROCARBAZINE 4',!0'12',# ô #2-.-1'"# '$-1.& +'"# +#2&-20#6 2# ô 4', * 12',# +#*.& * , .0#",'1-,# NNRTIs • 0'*.'4'0',#ô !MKNJCP? ô#BSP?LR ȖȖȖȖȖȖ

• #$ 4'0#,8ô η 1SQRGT? ô RPGNJ? η Ó(ENROG@LHCDÓ@BSHU@SHNMÓ η η • #20 4'0',#ô̜'LRCJCLAC̝ Ó$SNONRHCD and potentially more Ȗ Ó2SDQNHC Ȗ Potential vinca alkaloid • ,#4'0 .',#ô̜ Viramune ̝ MDTQNSNWHBÓLDS@ANKHSDR

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!'1.* 2', ô!72 0 ',# ô !7!*-.&-1.& +'"# ! 0 -.* 2', "#6 +#2& 1-,# 3Q@MRENQL@SHNMÓSNÓHM@BSHUDÓ@MCÓONRRHAKXÓ SNWHBÓLDS@ANKHSDRÓ"8/Ó (MGHAHSHNMÓNEÓ"8/ ÓL@XÓHMBQD@RDÓCQTFÓ @U@HK@AHKHSXÓENQÓGXCQNWXK@SHNMÓQNTSDÓ /NRRHAHKHSXÓNEÓHMBQD@RDCÓ /NRRHAHKHSXÓNEÓCDBQD@RDCÓ +#!& ,'1+ô-$ô (MCTBSHNMÓNEÓ"8/Ó ÓL@XÓHMBQD@RDÓ /NSDMSH@KÓ@CCHSHUDÓSNWHBHSXÓVHSGÓNSGDQÓ (MCTBSHNMÓNEÓ"8/ SGDQDAXÓKD@CHMFÓSNÓHMBQD@RDCÓDȑB@BXÓ CDW@LDSG@RNMDÓKDUDKRÓ KDUDKRÓVHSGÓ"8/ Ó SNWHBÓLDS@ANKHSD @FDMSRÓRTBGÓ@RÓSDMNENUHQÓQDM@KÓSNWHBHSX CDW@LDSG@RNMD ',2#0 !2'-, @MCÓSNWHBHSXÓNEÓBXBKNOGNROG@LHCD VHSGÓ"8/ ÓHMGHAHSNQR inducers "XO!Ó@MCÓ"8/"ÓHMCTBSHNMÓ by ritonavir may possibly increase the active metabolite

1HSNM@UHQÓ@MCÓBNAHBHRS@S + ',ô 1HSNM@UHQÓ@MCÓBNAHBHRS@S ANNRSDCÓ boosted protease $E@UHQDMY ÓDSQ@UHQHMD Ó /(R Ó--13(R ÓDKUHSDFQ@UHQ protease inhibitors and $E@UHQDMY ÓDSQ@UHQHMD ÓMDUHQ@OHMD 3DMNENUHQ ',2#0 !2',%ô HMGHAHSNQRÓ@MCÓBNAHBHRS@S nevirapine cobicistat, rilpivirine BNAHBHRS@S ANNRSDCÓDKUHSDFQ@UHQ ARVs boosted elvitegravir

/TKRDÓCNRHMFÓNEÓ CDW@LDSG@RNMDÓHRÓ.* ÓÓ #@HKXBGQNMHBÓ CITRSÓCNRDÓNQÓBNMRHCDQÓQDOK@BHMFÓ CITRSÓCNRDÓNQÓBNMRHCDQÓQDOK@BHMFÓ "KNRDÓLNMHSNQHMFÓNEÓSGDÓQDM@KÓETMBSHNMÓ -NÓCNRDÓ@CITRSLDMSÓ -NÓCNRDÓ@CITRSLDMSÓ CDW@LDSG@RNMDÓL@XÓ MANAGEMENT @MSHQDSQNUHQ@KRÓVHSGÓ@KSDQM@SDÓ@FDMSR @MSHQDSQNUHQ@KRÓVHSGÓ@KSDQM@SDÓ@FDMSR NQÓBNMRHCDQÓQDOK@BHMFÓSDMNENUHQ suggested suggested decrease antiretroviral drugs and should be @UNHCDCÓHEÓONRRHAKD

"KNRDÓLNMHSNQHMFÓNEÓRHCDÓDȎDBSRÓ "KNRDÓLNMHSNQHMFÓNEÓSGDÓQDM@KÓETMBSHNMÓ Close monitoring "KNRDÓLNMHSNQHMFÓNEÓRHCDÓDȎDBSR +-,'2-0',% MDTQNSNWHBHSX BQD@SHMD ÓTQHMDÓ@M@KXRHR NEÓRHCDÓDȎDBSR

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* Please note: These drug interaction websites generally check for interactions between HIV medications and other drugs. Interactions between combinations of non-HIV drugs are not checked. A MANAGEMENT TOOL FOR H V "03%̞"03%ô',2#0 !2'-,1

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