Page 80 - HIV/AIDS Guidelines

Table 6. Advantages and Disadvantages of Antiretroviral Components Recommended as
Initial Antiretroviral Therapy (page 4 of 4)

ARV ARV Advantages Disadvantages
Class Agent(s)
Dual-NRTI ABC/3TC • Virologic response noninferior to • Potential for ABC HSR in patients with HLA-B*5701
pairs (in ZDV/3TC • Increased potential for cardiovascular events, especially in
alphabetical • Better CD4 count responses than with patients with cardiovascular risk factors
order) ZDV/3TC • Inferior virologic responses in patients with baseline HIV RNA
• Once-daily dosing >100,000 copies/mL when compared with TDF/FTC in ACTG
• Coformulation 5202 study; however, this was not seen in the HEAT study.
• No food effect
• No cumulative TAM-mediated resistance
TDF/FTC • Better virologic responses than with • Potential for renal impairment, including Fanconi syndrome
ZDV/3TC and acute renal insufficiency
• Better virologic responses than with • Early virologic failure of NVP + TDF + (FTC or 3TC) in small
ABC/3TC in patients with baseline HIV clinical trials
RNA >100,000 copies/mL in ACTG 5202 • Potential for decrease in BMD
study; however, this was not seen in the
HEAT study.
• Active against HBV; recommended dual-
NRTI for HIV/HBV coinfection
• Once-daily dosing
• No food effect
• Coformulated (TDF/FTC, EFV/TDF/FTC,
and RPV/TDF/FTC)
• No cumulative TAM-mediated resistance
ZDV/3TC • Coformulated (ZDV/3TC and • Bone marrow suppression, especially anemia and neutropenia
ZDV/3TC/ABC) • GI intolerance, headache
• No food effect (although better tolerated • Mitochondrial toxicity, including lipoatrophy, lactic acidosis,
with food) hepatic steatosis
• Preferred dual NRTI in pregnant women • Compared with TDF/FTC, inferior in combination with EFV
• Less CD4 increase compared with ABC/3TC
• Twice-daily dosing

Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, APV = amprenavir, ART = antiretroviral therapy, ARV = antiretroviral, ATV = atazanavir,
ATV/r = atazanavir/ritonavir, AV = atrioventricular, BMD = bone mineral density, CNS = central nervous system, CYP = cytochrome P, d4T = stavudine,
ddI = didanosine, DRV/r = darunavir/ritonavir, ECG = electrocardiogram, EFV = efavirenz, FPV = fosamprenavir, FPV/r = fosamprenavir/ ritonavir,
FTC = emtricitabine, GI = gastrointestinal, HBV = hepatitis B virus, HSR = hypersensitivity reaction, INSTI = integrase strand transfer inhibitor,
LPV/r = lopinavir/ritonavir, MI = myocardial infarction, msec = milliseconds, MVC = maraviroc, NNRTI = non-nucleoside reverse transcriptase inhibitor,
NRTI = nucleoside reverse transcriptase inhibitor, NVP = nevirapine, PI = protease inhibitor, PPI = proton pump inhibitor, RAL = raltegravir,
RPV = rilpivirine, RTV = ritonavir, SJS = Stevens-Johnson syndrome, SQV/r = saquinavir/ritonavir, TAM = thymidine analogue mutation,
TDF = tenofovir, TEN = toxic epidermal necrosis, ZDV = zidovudine

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents F-19

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