Page 63 - HIV/AIDS Guidelines

optimalanddurablevirologicefficacy,favorabletolerabilityandtoxicityprofiles,andeaseofuse.
“Alternativeregimens”arethoseregimensthatareeffectivebuthavepotentialdisadvantageswhen
comparedwithpreferredregimens.Incertainsituationsandbasedonindividualpatientcharacteristicsand
needs,aregimenlistedasanalternativemayactuallybethepreferredregimenforaspecificpatient.
Comparedwithpreferredoralternativeregimens,someregimensareclassifiedas“acceptableregimens”
becauseofreducedvirologicactivity,lackofefficacydatafromlargeclinicaltrials,orotherfactors(suchas
greatertoxicities,pillburden,druginteractionpotential,orneedforadditionaltesting).

Lastly,thePanelclassifiedsomeregimensas“regimensthatareacceptablebutshouldbeusedwithcaution”
becauseofcertainsafetyorefficacyconcernsexplainedinTable5b.

Factors to Consider When Selecting an Initial Regimen

Regimenselectionshouldbeindividualizedonthebasisofanumberoffactors,includingthefollowing:

• comorbidconditions(e.g.,cardiovasculardisease[CVD],chemicaldependency,liverdisease,psychiatric
disease,renaldiseases,ortuberculosis[TB]);
• potentialadversedrugeffects;
• potentialdruginteractionswithothermedications;
• pregnancyorpregnancypotential;
• resultofgenotypicdrug-resistancetesting;

• genderandpretreatmentCD4countifconsideringnevirapine(NVP);
• HLA-B*5701testingifconsideringabacavir(ABC);
• coreceptortropismassayifconsideringmaraviroc(MVC);
• patientadherencepotential;and
• convenience(e.g.,pillburden,dosingfrequency,andfoodandfluidconsiderations).

Considerations for Therapies

AppendixB,Tables1–6 providealistingofcharacteristics,suchasformulations,dosingrecommendations,
pharmacokinetics(PKs),andcommonadverseeffects,ofindividualARVagents.Additionally,AppendixB,
Table7 providesclinicianswithARVdosingrecommendationsforpatientswhohaverenalorhepatic
insufficiency.

AninitialARVregimengenerallyconsistsoftwoNRTIsincombinationwithanNNRTI,aPI(preferably
boostedwithritonavir[RTV]),anINSTI(namelyraltegravir[RAL]),oraCCR5antagonist(namelyMVC).
Inclinicaltrials,NNRTI-,PI-,INSTI-,orCCR5antagonist-basedregimenshaveallresultedinHIVRNA
decreasesandCD4cellincreasesinalargemajorityofpatients. 1-7
Tables5aand5b includethePanel’srecommendationsforinitialtherapy.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents F-2

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