Antiretroviral therapy (ART) is recommended in all HIV-infected patients, regardless of CD4 cell count . However, some patients may have trouble taking combination regimens if they have difficulty swallowing due to other comorbidities, such as candidal esophagitis, or more permanent disabilities, such as stroke.
Fortunately, many antiretroviral medications are available as liquid preparations. In addition, for some medications there are methods for dissolving or crushing tablets, which are effective without losing drug potency.
Medication dosing options for the patient who has difficulty swallowing is reviewed below. Information about the general approach to selecting combination ART is reviewed elsewhere. (See "Selecting antiretroviral regimens for the treatment naive HIV-infected patient".)
It is important to understand that the milligram dosing of a liquid preparation may differ from the milligram dose of a tablet formulation, so a direct conversion shouldn’t be expected. A summary of the available liquid formulations is found in the accompanying table (table 1).
The manufacturer does not usually provide a measuring device in the packaging for most of these liquid products. In addition, pharmacists generally do not provide instruction or measuring devices unless specifically asked and they may not have time to properly instruct patients on how to use them. Therefore, patients often use whatever they consider to be a teaspoon, tablespoon, or ounce, all of which are significantly inaccurate. The volume of liquid delivered via various household teaspoons can range from 2 mL to 9 mL.