George Eliot Hospital Formulary

	George Eliot Hospital
	NHS Trust

Search

Formulary Chapter 5: Infections - Full Chapter

Notes:

The development of this chapter for the George Eliot Formulary is in progress

Chapter Links...

Antibiotic Formulary

Details...

05.03.01

HIV infection

Treatment aims to prevent the mortality and morbidity associated with chronic HIV infection whilst minimising drug toxicity. Although it should be started before the immune system is irreversibly damaged, the need for early drug treatment should be balanced against the risk of toxicity. Commitment to treatment and strict adherence over many years are required; the regimen chosen should take into account convenience and patient tolerance. Treatment also reduces the risk of HIV transmission to sexual partners, but the risk is not eliminated completely.

The optimum time for initiating antiretroviral treatment depends primarily on the CD4 cell count. The timing and choice of treatment should also take account of clinical symptoms, comorbidities and the possible effect of antiretroviral drugs on factors such as the risk of CV events. Treatment includes a combination of drugs known at 'highly active antretroviral therapy'.

05.03.01

Nucleoside reverse transcriptase inhibitors

05.03.01

Protease inhibitors

05.03.01

Non-nucleoside reverse transcriptase inhibitors

05.03.01

Other antiretrovirals

Dolutegravir

(Tivicay^®)

Formulary

Dolutegravir is a HIV-integrase inhibitor

Available as tablets
Hypersensitivity reactions (including severe rash, or rash accompanied by fever, malaise, arthralgia, myalgia, blistering, oral lesions, conjunctivitis, angiodema, eosinophilia or raised LFTs) reported uncommonly. Discontinue immediately if any sign or symptoms of hypersensitivity reactions develop.
If a dose is more than 20 hours late on the once daily regimen or more than 8 hours late on the twice daily regimen, the missed dose should not be taken and the next dose should be taken at the normal time.

MHRA/CHM advice: Dolutegravir (Tivicay, Triumeq, Juluca): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

Maraviroc

Formulary

Maraviroc is an antagonist of the CCR5 chemokine receptor.

Available as tablets

Raltegravir (Isentress ^®)

Formulary

Raltegravir is a HIV-integrase inhibitor

Available as tablets
Rash occurs commonly, discontinue if severe rash accompanied by fever, malaise, arthralgia, myalgia, blistering, mouth ulceration, conjunctivitis, angiodema, hepatitis or eosinophilia.

....

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.
	SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.
	SPECIALIST ADVISED – Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.
	SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]