Page 64 - HIV/AIDS Guidelines

Table 5a. Preferred and Alternative Antiretroviral Regimens for Antiretroviral Therapy-Naive
Patients
AcombinationARTregimengenerallyconsistsoftwoNRTIs+oneactivedrugfromoneofthefollowingclasses:
NNRTI,PI(generallyboostedwithRTV),INSTI,oraCCR5antagonist.Selectionofaregimenshouldbe
individualizedonthebasisofvirologicefficacy,toxicity,pillburden,dosingfrequency,drug-druginteraction
potential,resistancetestingresults,andthepatient’scomorbidconditions.RefertoTable6 foralistofadvantages
anddisadvantagesandAppendixB,Tables1–6 fordosinginformationforindividualARVagentslistedbelow.
Theregimensineachcategoryarelistedinalphabeticalorder.

Preferred Regimens (Regimens with optimal and durable efficacy, favorable tolerability and toxicity profile, and ease of use)
The preferred regimens for non-pregnant patients are arranged by chronological order of FDA approval of components other than
nucleosides and, thus, by duration of clinical experience.
NNRTI-Based Regimen Comments
a
• EFV/TDF/FTC (AI) EFV should not be used during the first trimester of pregnancy
or in women of childbearing potential who are trying to conceive
PI-Based Regimens (in alphabetical order) or not using effective and consistent contraception.
a
• ATV/r + TDF/FTC (AI)
a
• DRV/r (once daily) + TDF/FTC (AI) TDF should be used with caution in patients with renal
insufficiency.
INSTI-Based Regimen
a
• RAL + TDF/FTC (AI) ATV/r should not be used in patients who require >20 mg
omeprazole equivalent per day. Refer to Table 15a for dosing
Preferred Regimen for Pregnant Women b recommendations regarding interactions between ATV/r and
a
• LPV/r (twice daily) + ZDV/3TC (AI)
acid-lowering agents.
Alternative Regimens (Regimens that are effective and tolerable but have potential disadvantages compared with preferred
regimens. An alternative regimen may be the preferred regimen for some patients.)
NNRTI-Based Regimens (in alphabetical order) Comments
a
• EFV + ABC/3TC (BI) • Use RPV with caution in patients with pretreatment HIV RNA
a
• RPV/TDF/FTC (BI) >100,000 copies/mL.
a
• RPV + ABC/3TC (BIII) • Use of PPIs with RPV is contraindicated.
PI-Based Regimens (in alphabetical order) • ABC should not be used in patients who test positive for HLA-
a
• ATV/r + ABC/3TC (BI) B*5701.
a
• DRV/r + ABC/3TC (BIII) • Use ABC with caution in patients with known high risk of CVD
a
a
• FPV/r (once or twice daily) + ABC/3TC or TDF/FTC (BI) or with pretreatment HIV RNA >100,000 copies/mL. (See text.)
a
a
• LPV/r (once or twice daily) + ABC/3TC or TDF/FTC (BI)
Once-daily LPV/r is not recommended for use in pregnant
INSTI-Based Regimen women.
a
• RAL + ABC/3TC (BIII)
a 3TC may substitute for FTC or vice versa.
b For more detailed recommendations on ARV use in an HIV-infected pregnant woman, refer to the perinatal guidelines available at
http://aidsinfo.nih.gov/guidelines.
The following combinations in the recommended list above are available as coformulated fixed-dose combinations: ABC/3TC, EFV/TDF/FTC,
LPV/r, RPV/TDF/FTC, TDF/FTC, and ZDV/3TC.
Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, ART = antiretroviral therapy, ARV = antiretroviral, ATV/r = atazanavir/ritonavir,
CVD = cardiovascular disease, DRV/r = darunavir/ritonavir, EFV = efavirenz, FDA = Food and Drug Administration, FPV/r = fosamprenavir/
ritonavir, FTC = emtricitabine, INSTI = integrase strand transfer inhibitor, LPV/r = lopinavir/ritonavir, NNRTI = non-nucleoside reverse
transcriptase inhibitor, NRTI = nucleos(t)ide reverse transcriptase inhibitor, PI = protease inhibitor, PPI = proton pump inhibitor,
RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir, TDF = tenofovir, ZDV = zidovudine

Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = data from randomized controlled trials; II = data from well-designed nonrandomized trials or observational cohort
studies with long-term clinical outcomes; III = expert opinion

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents F-3

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