Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral
Therapy (continued)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
NNRTIs EFV • Virologic responses non-
inferior or superior to
most comparators
• Virologic potency
persists regardless of
baseline HIV RNA
• Once-daily dosing
• Co-formulated with
TDF/FTC
• Long-term clinical
experience
• Transmitted resistance more
common than with PIs
• Short-and long-term
neuropsychiatric side effects,
including depression and
suicidality
• Teratogenic in non-human
primates; avoid use in women
who are trying to conceive or
who are sexually active and not
using contraception
• Dyslipidemia
• Greater risk of resistance at the
time of treatment failure than
with PIs
• Skin rash
• Potential for CYP450 drug
interactions
• Should be taken on an empty
stomach (food increases drug
absorption and CNS toxicities)
RPV • Once-daily dosing
• Co-formulated with
TDF/FTC
• Smaller pill size than co-
formulated EFV/TDF/
FTC or EVG/cobi/
TDF/FTC
• Compared with EFV:
> Fewer discontinuations
for CNS adverse effects
> Fewer lipid effects
> Fewer rashes
> Smaller pill size
• Not recommended in patients
with pre-ART HIV RNA
>100,000 copies/mL or CD4
count <200 cells/mm
3
because
of higher rate of virologic failure
in these patients
• Transmitted resistance more
common than with PIs
• More NNRTI-, TDF-, and
3TC-associated mutations at
virological failure than with
regimen containing EFV and
two NRTIs
• Potential for CYP450 drug
interactions
• Meal requirement
• Requires acid for adequate
absorption
• Contraindicated with PPIs
• Use with H2 antagonists or
antacids with caution
• RPV-associated depression
reported
• Use with caution when co-
administered with a drug having a
known risk of torsades de pointes.
3
