Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral
Therapy (continued)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
INSTIs DTG • Once-daily dosing
• DTG-containing
regimens have higher
rates of virologic
suppression than EFV-
or DRV/r- containing
regimens, largely
because of fewer drug
discontinuations.
• May have higher barrier
to resistance than EVG
or RAL
• Demonstrated virologic
potency with both TDF/
FTC and ABC/3TC
regardless of pre-ART
HIV RNA level
• Effective at double dose
(50 mg twice daily)
against some RAL- and
EVG-resistant viruses
• No food requirement
• No CYP3A4 interactions
• Inhibits renal tubular secretion
of creatinine and can increase
serum creatinine without
affecting glomerular function
• Oral absorption can be reduced
by simultaneous administration
with products containing
polyvalent cations (eg, Al
+++
,
Ca
++
, or Mg
++
containing
antacids or supplements, or
multivitamin tablets with
minerals)
• UGT substrate: potential for
drug interactions
EVG • Co-formulated with
cobi/TDF/FTC
• Once daily dosing
• Non-inferior to EFV/
TDF/FTC and ATV/r
plus TDF/FTC
• EVG is only recommended for
patients with baseline CrCl
≥70 mL/min; therapy should be
discontinued if CrCl decreases to
<50 mL/min.
• Cobi is a potent CYP3A4
inhibitor, which can result in
significant interactions with
CYP3A substrates.
• Oral absorption can be reduced
by simultaneous administration
with antacids containing
polyvalent cations, such as Al
+++
or Mg
++
.
• Cobi inhibits active tubular
secretion of creatinine and
can increase serum creatinine,
without affecting renal
glomerular function.
• Has potential for new onset or
worsening of renal impairment
• May have lower genetic barrier to
resistance than seen with boosted
• PI- or DTG-based regimens
• Food requirement
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