Page 65 - HIV/AIDS Guidelines

Table 5b. Acceptable Antiretroviral Regimens for Treatment-Naive Patients

Acceptable Regimens (CI) (Regimens that may be selected for some patients but are less satisfactory than preferred or alternative
regimens) and Regimens that may be acceptable but more definitive data are needed (CIII)
NNRTI-Based Regimen Comments
a
• EFV + ZDV/3TC (CI) • NVP should not be used in patients with moderate to severe
a
a
• NVP + (TDF/FTC or ZDV/3TC ) (CI) hepatic impairment (Child-Pugh B or C). b
a
• NVP + ABC/3TC (CIII) • NVP should not be used in women with pre-ART
3
a
• RPV + ZDV/3TC (CIII) CD4 count >250 cells/mm or in men with pre-ART
3
CD4 count >400 cells/mm .
PI-Based Regimens
a
• ATV + (ABC or ZDV)/3TC (CI) Use NVP and ABC together with caution because both can cause
a
• ATV/r + ZDV/3TC (CI) HSRs within the first few weeks after initiation of therapy.
a
• DRV/r + ZDV/3TC (CIII)
a
• FPV/r + ZDV/3TC (CI) ZDV can cause bone marrow suppression, lipoatrophy, and
a
• LPV/r + ZDV/3TC (CIII) rarely lactic acidosis with hepatic steatosis.
LPV/r (twice daily) + ZDV/3TC is the preferred regimen for use
INSTI-Based Regimen
a
• RAL + ZDV/3TC (CIII) in pregnant women.
ATV/r is generally preferred over unboosted ATV. Unboosted ATV
CCR5 Antagonist-Based Regimens
a
• MVC + ZDV/3TC (CI) may be used when RTV boosting is not possible.
a
a
• MVC + TDF/FTC or ABC/3TC (CIII) Perform tropism testing before initiation of therapy with MVC.
MVC may be considered in patients who have only CCR5-tropic
virus.
Regimens that may be acceptable but should be used with caution (Regimens that have demonstrated virologic efficacy in
some studies but are associated with concerns about safety, resistance, or efficacy. See comments below.)
PI-Based Regimens Comments
a
• SQV/r + TDF/FTC (CI) • SQV/r was associated with PR and QT prolongation in a healthy
volunteer study.
a
• SQV/r + (ABC or ZDV)/3TC (CIII) • Baseline ECG is recommended before initiation of SQV/r.
• SQV/r is not recommended in patients with any of the
following:
1. pretreatment QT interval >450 msec
2. refractory hypokalemia or hypomagnesemia
3. concomitant therapy with other drugs that prolong QT
interval
4. complete AV block without implanted pacemaker
5. risk of complete AV block
a 3TC may substitute for FTC or vice versa.
b Refer to Appendix B, Table 7 for the criteria for Child-Pugh classification
Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, ART = antiretroviral therapy, ATV = atazanavir, ATV/r = atazanavir/ritonavir,
AV = atrioventricular, DRV/r = darunavir/ritonavir, ECG = electrocardiogram, EFV = efavirenz, FPV/r = fosamprenavir/ ritonavir, FTC = emtricitabine,
HSR = hypersensitivity reaction, INSTI = integrase strand transfer inhibitor, LPV/r = lopinavir/ ritonavir, msec = millisecond, MVC = maraviroc,
NNRTI = non-nucleoside reverse transcriptase inhibitor, NVP = nevirapine, PI = protease inhibitor, RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir,
SQV/r = saquinavir/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-4

Downloaded from http://aidsinfo.nih.gov/guidelines on 12/8/2012 EST.