5
Table 3. Antiretroviral Regimens for Antiretroviral Therapy–
Naive Patients (Updated October 2013) (cont'd)
Regimens That May Be Acceptable But More Definitive Data Are Needed
NNRTI-Based Regimens
Î NVP
i,l
+ ABC
d
/3TC
b
(CIII)
Î RPV
g
+ZDV
e
/3TC
b
(CIII)
CCR5 Antagonist-Based Regimen
Î MVC
k
+ (TDF/FTC
b
or
ABC
d
/3TC
b
) (CIII)
INSTI-Based Regimen
Î RAL + ZDV
e
/3TC
b
(CIII)
PI-Based Regimen
Î DRV/r + ZDV
e
/3TC
b
(CIII)
Regimens That May Be Acceptable But Should Be Used With Caution
(Regimens that have demonstrated virologic efficacy in some studies, but have safety, resistance, or
efficacy concerns.)
PI-Based Regimens
Î SQV/r
m
+ TDF/FTC
b
(CI)
Î SQV/r
m
+ (ABC
d
or ZDV
e
)/3TC
b
(CIII)
a
EFV should NOT be used during the first trimester of pregnancy or in women trying to conceive or
not using effective and consistent contraception.
b
3TC may substitute for FTC or vice versa.
c
ATV/r should NOT be used in patients who require > 20 mg omeprazole equivalent per day.
d
ABC should NOT be used in patients who test positive for HLA-B*5701. Use with caution in patients
with high risk of cardiovascular disease or with pretreatment HIV-RNA >100,000 copies/mL.
e
ZDV can cause bone marrow suppression, lipoatrophy, and rarely lactic acidosis with hepatic
steatosis.
f
If CrCl ≥70 mL/min.
g
RPV must be taken with a meal. It is contraindicated in patients taking proton-pump inhibitors
(PPIs); use with caution with H
2
-receptor antagonists and antacids. Recommended only in patients
with viral load ≤100,000 copies/mL.
h
Once-daily LPV/r is NOT recommended in pregnant women.
i
NVP should NOT be used in patients with moderate to severe hepatic impairment (Child-Pugh
B or C). NVP should NOT be used in women with pre-ARV CD4 > 250 cells/mm
3
or men with
pre-ARV CD4 >400 cells/mm
3
.
j
ATV/r is generally preferred over ATV. Unboosted ATV may be used when ritonavir boosting is not possible.
k
With MVC, tropism testing is required before treatment. Only patients found to have only CCR5-
tropic virus are candidates for MVC.
l
Use NVP and ABC together with caution because both can cause hypersensitivity reactions within
first few weeks aer initiation of therapy.
m
• SQV/r was associated with PR and QT prolongation in a healthy volunteer study.
• Baseline ECG is recommended before initiation of SQV/r.
• SQV/r is NOT recommended in patients with any of the following :
1. Pretreatment QT interval >450 msec
2. Refractory hypokalemia or hypomagnesemia
3. Concomitant therapy with other drugs that prolong QT interval
4. Complete AV block without implanted pacemaker
5. Risk of complete AV block
n
In patients who test negative for HLA-B*5701.
