Selecting a Treatment Regimen
Table 7. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral Therapy
ARV
Agent(s) Advantages Disadvantages
PIs
a
(cont'd)
DRV/r
• Once-daily dosing
• Potent virologic
efficacy
• Skin rash
• Food requirement
FPV/r
• Twice-daily dosing
resulted in efficacy
comparable to LPV/r
• RTV boosting results
in higher trough APV
concentration and
greater antiviral effect
• Once-daily dosing
possible with RTV
100 mg or 200 mg
daily
• No food effect
• Skin rash
• Hyperlipidemia
• Once-daily dosing results in lower APV
concentrations than twice-daily dosing
• For FPV 1,400 mg + RTV 200 mg :
requires 200 mg of RTV and no
coformulation
• Fewer data on FPV 1,400 mg + RTV
100 mg dose than on DRV/r and ATV/r
LPV/r
• Coformulated
• No food requirement
• Recommended PI
in pregnant women
(twice daily only)
• Greater CD4 count
increase than with
EFV-based regimens
• Requires 200 mg per day of RTV
• Lower drug exposure in pregnant women—
may need dose increase in third trimester
• Once-daily dosing not recommended in
pregnant women
• Once-daily dosing results in lower trough
concentration than twice-daily dosing
• 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.
SQV/r
• Similar efficacy but
less hyperlipidemia
than with LPV/r
• Highest pill burden (6 pills per day) among
available PI regimens
• Requires 200 mg of RTV
• Food requirement
• PR and/or QT interval prolongations in a
healthy volunteer study
• Pretreatment ECG recommended
• SQV/r is not recommended for patients
with any of the following conditions: (1)
congenital or acquired QT prolongation;
(2) pretreatment ECG >450 msec; (3) on
concomitant therapy with other drugs that
prolong QT interval; (4) complete AV
block without implanted pacemakers; (5)
risk of complete AV block.
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