Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral
Therapy (continued)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
PIs ATV/r • Once-daily dosing
• Higher genetic barrier to
resistance than NNRTIs,
EVG, and RAL
• PI resistance at the time
of treatment failure
uncommon with RTV-
boosted PIs
• Commonly causes indirect
hyperbilirubinemia, which
may manifest as scleral icterus
or jaundice
• Food requirement
• Absorption depends on food
and low gastric pH
• Nephrolithiasis, cholelithiasis,
nephrotoxicity
• GI adverse effects
• CYP3A4 inhibitors and
substrates: potential for drug
interactions
DRV/r • Once-daily dosing
• Higher genetic barrier to
resistance than NNRTIs,
EVG, and RAL
• PI resistance at the time
of treatment failure
uncommon with RTV-
boosted PIs
• Skin rash
• Food requirement
• GI adverse effects
• CYP3A4 inhibitors and
substrates: potential for drug
interactions
LPV/r • Only PI co-formulated
with RTV
> May reduce the number
of patient co- pays
(out-of-pocket cost)
> Can prevent patient
from inadvertently
not taking RTV or the
active PI
• No food requirement
• Once or twice daily
dosing
• Requires 200 mg per day of
RTV
• Once-daily dosing not
recommended in pregnant
women
• Possible higher risk of MI
associated with cumulative use
of LPV/r
• PR and QT interval
prolongation have been
reported. Use with caution
in patients at risk of cardiac
conduction abnormalities or
receiving other drugs with
similar effect.
• Possible nephrotoxicity
• CYP3A4 inhibitors and
substrates: potential for drug
interactions
Selecting a Treatment Regimen
4
