The World Health Organization (WHO) provided guidance for evaluating a patient with possible toxicity due to antiretroviral drug therapy.
Toxic reactions to antiretroviral therapy is graded using the Common Toxicity Criteria (CTC):
|
Reaction |
Severity of Reaction |
Grade |
|
no limitation on activity; mild, transient discomfort; no medical intervention needed |
mild |
Grade 1 |
|
some limitation of activity, may need some help; minimal medical intervention needed |
moderate |
Grade 2 |
|
marked limitation of activity; medical intervention required; may need to be hospitalized |
severe |
Grade 3 |
|
extreme limitation of activity; requires significant assistance; significant medical intervention required; usually hospitalized and may need critical care |
life-threatening |
Grade 4 |
Guidance:
(1) Grade the severity of the adverse reaction.
(2) Confirm that the reaction is due to the medication and not due to some other cause.
(3) Respond appropriately based on the severity of the adverse reaction (see below).
(4) Emphasize the need for adherence despite discomfort.
(5) If the presence of a Grade 4 reaction necessitates discontinuation of an antiretroviral drug, then discontinue all antiretroviral drugs until the patient has stabilized from the acute insult.
|
Grade |
Appropriate Response |
|
Grade 1 |
continue regimen; make any adjustments that may reduce symptoms |
|
Grade 2 |
try to continue regimen; if unable to do so then consider single-drug substitution |
|
Grade 3 |
single drug substitution of the implicated drug |
|
Grade 4 |
discontinue all antiretroviral drugs and stabilize the patient; after recovery restart a regimen that removes the offending drug |
Purpose: To evaluate an HIV-positive patient with possible adverse reaction to antiretroviral therapy using the WHO recommendations.
Specialty: Infectious Diseases, Pharmacology, clinical
Objective: dosage adjustments, response to therapy, adverse effects
ICD-10: B20,
