Page 91 - HIV/AIDS Guidelines

Table 8. Antiretroviral Regimens or Components That Should Not Be Offered At Any Time (page 1 of 2)

Rationale Exception
Antiretroviral Regimens Not Recommended
Monotherapy with NRTI (AII) • Rapid development of resistance • No exception
• Inferior ARV activity when compared with
combination of three or more ARV agents
Dual-NRTI regimens (AI) • Rapid development of resistance • No exception
• Inferior ARV activity when compared with
combination of three or more ARV agents

Triple-NRTI regimens (AI) except • High rate of early virologic nonresponse seen • ABC/ZDV/3TC (BI) and possibly
for ABC/ZDV/3TC (BI) when triple-NRTI combinations, including TDF + ZDV/3TC (BII) in patients in
or possibly TDF + ZDV/3TC (BII) ABC/TDF/3TC and TDF/ddI/3TC, were used as whom other combinations are not
initial regimen in ART-naive patients. desirable
• Other triple-NRTI regimens have not been
evaluated.
Antiretroviral Components Not Recommended as Part of an Antiretroviral Regimen
ATV + IDV (AIII) • Potential additive hyperbilirubinemia • No exception

ddI + d4T (AII) • High incidence of toxicities: peripheral neuropathy, • No exception
pancreatitis, and hyperlactatemia
• Reports of serious, even fatal, cases of lactic
acidosis with hepatic steatosis with or without
pancreatitis in pregnant women
ddI + TDF (AII) • Increased ddI concentrations and serious ddI- • Clinicians caring for patients who are
associated toxicities clinically stable on regimens
containing TDF + ddI should
• Potential for immunologic nonresponse and/or
CD4 cell count decline consider altering the NRTIs to avoid
this combination.
• High rate of early virologic failure
• Rapid selection of resistance mutations at failure

2-NNRTI combination (AI) • When EFV combined with NVP, higher incidence of • No exception
clinical adverse events seen when compared with
either EFV- or NVP-based regimen.
• Both EFV and NVP may induce metabolism and
may lead to reductions in ETR exposure; thus, they
should not be used in combination with ETR.
EFV in first trimester of pregnancy • Teratogenic in nonhuman primates • When no other ARV options are
or in women with significant available and potential benefits
childbearing potential (AIII) outweigh the risks (BIII)

FTC + 3TC (AIII) • Similar resistance profiles • No exception
• No potential benefit

ETR + unboosted PI (AII) • ETR may induce metabolism of these PIs; • No exception
appropriate doses not yet established
ETR + RTV-boosted ATV or FPV • ETR may alter the concentrations of these PIs; • No exception
(AII) appropriate doses not yet established
ETR + RTV-boosted TPV (AII) • ETR concentration may be significantly reduced by • No exception
RTV-boosted TPV

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

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