Page 90 - HIV/AIDS Guidelines

Efavirenz (EFV) in first trimester of pregnancy and in women with significant childbearing potential.
EFV use was associated with significant teratogenic effects in nonhuman primates at drug exposures similar
to those representing human exposure. Several cases of congenital anomalies have been reported after early
human gestational exposure to EFV. 25-26 EFV should be avoided in pregnancy, particularly during the first
trimester, and in women of childbearing potential who are trying to conceive or who are not using effective
and consistent contraception (AIII). If no other ARV options are available for the woman who is pregnant or
at risk of becoming pregnant, the provider should consult with a clinician who has expertise in both HIV
1
infection and pregnancy. (See Perinatal Guidelines, available at http://aidsinfo.nih.gov.)
Emtricitabine (FTC) + lamivudine (3TC). Both of these drugs have similar resistance profiles and have
minimal additive antiviral activity. Inhibition of intracellular phosphorylation may occur in vivo, as seen with
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other dual-cytidine analog combinations. These two agents should not be used as a dual-NRTI
combination (AIII).
Etravirine (ETR) + unboosted PI. ETR may induce the metabolism and significantly reduce the drug
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exposure of unboosted PIs. Appropriate doses of the PIs have not been established (AII).
Etravirine (ETR) + ritonavir (RTV)-boosted atazanavir (ATV) or fosamprenavir (FPV). ETR may alter
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the concentrations of these PIs. Appropriate doses of the PIs have not been established (AII).
Etravirine (ETR) + ritonavir (RTV)-boosted tipranavir (TPV). RTV-boosted TPV significantly reduces
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ETR concentrations. These drugs should not be coadministered (AII).
Nevirapine (NVP) initiated in ARV-naive women with CD4 counts >250 cells/mm or in ARV-naive
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men with CD4 counts >400 cells/mm . Greater risk of symptomatic hepatic events, including serious and
life-threatening events, has been observed in these patient groups. NVP should not be initiated in these
patients (BI) unless the benefit clearly outweighs the risk. 28-30 Patients who experience CD4 count increases
to levels above these thresholds as a result of antiretroviral therapy (ART) can be safely switched to NVP. 31
Unboosted darunavir (DRV), saquinavir (SQV), or tipranavir (TPV). The virologic benefit of these PIs
has been demonstrated only when they were used with concomitant RTV. Therefore, use of these agents as
part of a combination regimen without RTV is not recommended (AII).
Stavudine (d4T) + zidovudine (ZDV). These two NRTIs should not be used in combination because of
antagonism demonstrated in vitro and in vivo (AII).
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Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents G-2

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