Selecting a Treatment Regimen
Table 7. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral Therapy
ARV
Agent(s) Advantages Disadvantages
NNRTIs
a
NNRTI class advantages:
• Long half-lives
NNRTI class disadvantages:
• Greater risk of resistance at the time of
treatment failure with NNRTIs than with
PIs
• Potential for cross-resistance
• Skin rash
• Potential for CYP450 drug interactions
• Transmitted resistance more common with
NNRTIs than with PIs
EFV
• Virologic responses
equivalent or
superior to all
comparators to date
• Once-daily dosing
• Coformulated with
TDF/FTC
• Neuropsychiatric side effects
• Teratogenic in nonhuman primates.
Several cases of neural tube defect in
infants born to women who were exposed
to EFV in the first trimester of pregnancy
reported. EFV use should be avoided in
women with potential for pregnancy and is
contraindicated in the first trimester.
• Dyslipidemia
NVP
• No food effect
• Fewer lipid effects
than EFV
• Once-daily dosing
with extended-
release tablet
formulation
• Higher incidence of rash, including rare
but serious HSRs (SJS or TEN), than with
other NNRTIs
• Higher incidence of hepatotoxicity,
including serious and even fatal cases of
hepatic necrosis, than with other NNRTIs
• Contraindicated in patients with moderate
or severe (Child-Pugh B or C) hepatic
impairment
• Some data suggest that ART-naive patients
with high pre-NVP CD4 counts (>250
cells/mm
3
for females, >400 cells/mm
3
for
males) are at higher risk of symptomatic
hepatic events. NVP is not recommended
in these patients unless benefit clearly
outweighs risk.
• Early virologic failure of NVP + TDF +
(FTC or 3TC) in small clinical trials
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