Selecting a Treatment Regimen
Initiating Antiretroviral Therapy in Treatment-Naive Patients
Î Antiretroviral therapy (ART) is recommended for all HIV-infected
individuals to reduce the risk of disease progression.
• The strength of and evidence for this recommendation vary by pretreatment
CD4 count: CD4 count <350 (AI); 350 to 500 (AII); >500 cells/mm
3
(BIII).
Î ART is also recommended for HIV-infected individuals to prevent
transmission of HIV.
• The strength of and evidence for this recommendation vary by transmission risks:
perinatal transmission (AI); heterosexual transmission (AI); other transmission
risk groups (AIII).
Î Patients starting ART should be willing and able to commit to
treatment and understand the benefits and risks of therapy and the
importance of adherence (AIII).
• Patients may choose to postpone therapy, and providers, on a case-by-case basis,
may elect to defer therapy on the basis of clinical and/or psychosocial factors.
What to Start: Initial Combination Regimens for the
Antiretroviral-Naive Patient
Recommended and Alternative Antiretroviral Regimen Options
for Treatment-Naive Patients
Î An antiretroviral regimen generally consists of two NRTIs plus
one active drug from one of the following classes: non-nucleoside
reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI)
(boosted with ritonavir [RTV]), or integrase strand transfer inhibitors
(INSTI). Selection of a regimen should be individualized on the basis
of virologic efficacy, potential adverse effects, pill burden, dosing
frequency, drug-drug interaction potential, resistance test results
and comorbid conditions, and cost. Table 1 lists the advantages and
disadvantages of the ARV components listed below. For more detailed
recommendations on ARV choices and dosing in HIV-infected pregnant
women, refer to the latest perinatal guidelines available at http://
aidsinfo.nih.gov/guidelines.
