A higher risk of renal impairment has been reported in HIV-1 infected patients receiving tenofovir disoproxil fumarate in combination with a ritonavir boosted protease inhibitor. Close monitoring of renal function is required in these patients. In HIV-1 infected patients with renal risk factors, the co-administration of tenofovir disoproxil fumarate with a boosted protease inhibitor should be carefully evaluated. Coadministration of lopinavir/ritonavir (400/100 mg twice daily) was studied with tenofovir disoproxil fumarate (300 mg once daily). There was no change in lopinavir AUC, Cmax or Cmin. Tenofovir AUC increased by 32%, there was no change in Cmax and Cmin increased by 51%. Co-administration of lopinavir/ritonavir and emtricitabine has not been studied. No dose adjustment is recommended. The increased exposure of tenofovir could potentiate tenofovir associated adverse events, including renal disorders. Renal function should be closely monitored.

Coadministration increases tenofovir concentrations. Coadministration of lopinavir/ritonavir (400/100 mg twice daily) and tenofovir-DF (300 mg once daily) was studied in 24 subjects. There was no change tenofovir Cmax, but AUC and Cmin increased by 32% and 51%. Cmax, AUC and Cmin of lopinavir and ritonavir were unaltered. Monitor patients receiving Truvada concomitantly with lopinavir/ritonavir for TDF-associated adverse reactions. Discontinue Truvada in patients who develop TDF-associated adverse reactions.