Selecting a Treatment Regimen
Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral
Therapy (continued)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
INSTIs RAL • Longest post
marketing
experience in
comparison to
other INSTIs
• No food
requirement
• No CYP3A4
interactions
• Twice-daily dosing
• May have lower genetic barrier to
resistance than seen with boosted
• PI- or DTG-based regimens
• Increase in creatine kinase, myopathy,
and rhabdomyolysis have been reported.
• Rare cases of severe hypersensitivity
reactions (including SJS and TEN) have
been reported.
• Metal-containing antacids can
reduce the absorption of RAL. Co-
administration of RAL with Al
+++
and/or Mg
++
-containing antacids is
not recommended. RAL may be co-
administered with CaCO
3
containing
antacids
• UGT substrate: potential for drug
interactions
6
Co-Receptor Tropism Assays
Î A co-receptor tropism assay should be performed whenever the use of
a CCR5 co-receptor antagonist is being considered (AI).
Î Co-receptor tropism testing is also recommended for patients who
exhibit virologic failure on a CCR5 antagonist (BIII).
Î A phenotypic tropism assay is preferred to determine HIV-1
co-receptor usage (AI).
Î A genotypic tropism assay should be considered as an alternative test
to predict HIV-1 co-receptor usage (BII).
HLA-B*5701 Screening
(Last updated December 1, 2007; last reviewed January 10, 2011)
Î The Panel recommends screening for HLA-B*5701 before starting
patients on an abacavir (ABC)-containing regimen to reduce the risk of
hypersensitivity reaction (HSR) (AI).
Î HLA-B*5701-positive patients should NOT be prescribed ABC (AI).
Î The positive status should be recorded as an ABC allergy in the
patient's medical record (AII).
Î When HLA-B*5701 screening is not readily available, it remains
reasonable to initiate ABC with appropriate clinical counseling and
monitoring for any signs of HSR (CIII).
