Nucleoside/Nucleotide RTI - |
Combivir (zidovudine + lamivudine)
Emtriva (emtricitabine)
Epivir (lamivudine, 3TC)
Epzicom (lamivudine + abacavir)
Hivid (zalcitabine) Patients currently on medication may continue. No additional patients will be allowed to start on this medication.
Retrovir (zidovudine, AZT, ZDV)
Trizivir (abacavir + lamivudine + zidovudine)
Truvada (emtricitabine + tenofovir)
Videx (didanosine, DDI)
Videx EC (DDI enteric coated)
Viread (tenofovir)
Zerit (stavudine, D4T)
Ziagen (abacavir)
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Non-Nucleoside Reverse Transcriptase Inhibitors - |
Rescriptor (delavirdine, DVD)
Sustiva (efavirenz)
Viramune (nevirapine)
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Fuzeon (enfuvirtide)*CD4<150 or CD4%<10%,
With evidence of viral replication despite on going antiretroviral therapy. Fuzeon must be used in conjunction with other antiretroviral medications.CD4 and viral load are needed every 3 months. Medication Exception Form Required.
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Agenerase (amprenavir) Patients currently on this medication may continue. No additional patients will be allowed to start on this medication.
Aptivus (tipranavir)*Client must have CD4<300 and virologic failure on at least two protease inhibitors (viral load greater than 1,000 copies while on treatment regimen) at twoseparate times (Failure on a single course of one protease inhibitor boosted with ritonavir does NOT meet this requirement) OR documented genotypic or phenotypic resistance to at least two protease inhibitors with a history of prior exposure to at least two protease inhibitors. Medication Exception Form required.
Crixivan (indinavir, IDV)
Fortovase (saquinavir soft-gels)
Invirase (saquinavir, SQV)
Kaletra (lopinavir/ritonavir)
Lexiva (fosamprenavir)
Norvir (ritonavir, RTV) Abbott Laboratories, Abbott Laboratories, manufacturer of Norvir, is currently making this medication available to clients who are on 400 mg per day or higher without charge to client or ADAP through their Patient Assistance Program. Clients or medical providers can contact the program directly at 1-800-222-6885. The website address is www.abbott.com. For more information, contact VDH ADAP Coordinator at (804) 864-8019
Reyataz (atazanavir)
Viracept (nelfinavir, NFV)
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| Opportunistic Infection Protection/Treatment – |
Aerosolized Pentamidine AP Have or had active thrush or have a CD4 of 250 or less.
Amikin (amikacin)
Bactrim/Septra (TMP/SMX) Have a CD4 count of <250 or active thrush
Biaxin (clarithromycin)
Capastat (capreomycin)
Cleocin (clindamycin) (oral)
Cytovene IV (ganciclovir, DHPG)
Cytovene oral (ganciclovir) Patients currently on this medication may continue. No additional patients will be allowed to start on this medication.
Dapsone Have a CD4 count of <250 or active thrush
Daraprim (pyrimethamine)
Deltasone (prednisone)* Only authorized for the treatment of toxoplasmosis, Pneumocyctis carini pneumonia, and aphthous ulcers. Medication Exception Form Required
Diflucan (fluconazole po)
Famvir (famcyclovir) - for Herpes Zoster only
Foscavir IV (foscarnet)
INH (isoniazid)
Levoquin (levofloxacin)
Mepron (atovaquone) Have or had active thrush or have a CD4 count of 250 or less.
Microsulfon (sulfadiazine)
Myambutol (Ethambutol)
Mycobutin (rifabutin) Have a CD4 count of 100 or less. For treatment of MAI, only for those clients currently on it and those unable to tolerate Zithromax.
Paser (para-aminosalicylic acid)
Primaquine
Rifadin (rifampin)
Seromycin (cycloserine)
Sporanox (itraconazole)
Tebrazid (pyrazinamide)
Trecator (ethionamide)
Trimethoprim Have a CD4 count of <250 or active thrush Valcyte (valgancyclovir HCL)
Vistide (cidofovir)
Vitamin B6 (pyridoxine)
VFend (voriconazole)* Only authorized forfluconazole resistant candidiasis, treatment failure of candidiasis after utilizing itraconazole, and for the treatment of invasive aspergillus.ADAP Medication Exception Form documenting authorized indications in the “Reason for Exception” section is required. An updated exception form is required for each prescription.
Medication Exception Form Required
Zithromax (azithromycin) Have a CD4 count of <250 or active thrush
Zovirax (acyclovir po)
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Megace (Megesterol)
Procrit (epoetin alfa)
Wellcovorin (leukovorin)
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| Hepatitis C Treatment - |
Copegus (ribavirin)
Pegasys (peginterferon-alfa2a)**
Rebetol (ribavirin)** Shering Plough, Manufacturer of peginterferon alfa-2b, is currently making this medication available, without charge to clients or ADAP, through its Commitment to Community Program. To access this medication, contact the VDH ADAP Coordinator at 804-864-8019.
Peg-Intron (peginterferon-alfa2b) **Shering Plough, manufacturer of peginterferon alfa-2b, is currently making this medication available, without charge to clients or ADAP, through its Commitment to Community Program. To access this medication, contact the VDH ADAP Coordinator at 804-864-8019.
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| Vaccines - |
Hepatitis A
Hepatitis A/B
Hepatitis B
Influenza
Pneumovax
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* ADAP Medication Exception Form documenting authorized indications in the “Reason for Exception” section is required. Contact VDH ADAP Coordinator at (804) 864-8019 for more information or log on to Medication Exception Form
**Monthly prescriptions needed.
