Emtricitabine Disease Interactions

Severe acute exacerbations of HBV have been reported in HIV-1/HBV-coinfected patients who have discontinued products containing emtricitabine, lamivudine, and/or tenofovir disoproxil fumarate (DF) and may occur with discontinuation of tenofovir alafenamide-containing products. It is recommended that all patients with HIV-1 infection be tested for the presence of HBV before or when initiating products containing emtricitabine, lamivudine, tenofovir DF, or tenofovir alafenamide. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in HIV-1/HBV-coinfected patients who discontinue products (including fixed-dose combination products) that contain emtricitabine, lamivudine, tenofovir DF, or tenofovir alafenamide. If appropriate, initiation or resumption of antihepatitis B therapy may be warranted, especially in patients with advanced liver disease or cirrhosis since posttreatment exacerbation of hepatitis may lead to hepatic decompensation and liver failure.

Emtricitabine is removed by hemodialysis. When started within 1.5 hours of emtricitabine dosing, about 30% of the dose was removed over a 3-hour hemodialysis session (blood flow rate of 400 mL/min and a dialysate flow rate of 600 mL/min). If dosing on day of hemodialysis, emtricitabine should be administered after hemodialysis.

Emtricitabine is primarily eliminated by the kidney. Dosage adjustment of emtricitabine is recommended for patients with CrCl below 50 mL/min or in patients with ESRD requiring dialysis, in accordance with the manufacturer product information. Clinical response to treatment and renal function should be closely monitored.