Table 7. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial Antiretroviral Therapy
ARV
Agent(s) Advantages Disadvantages
INSTI
RAL
• Virologic response
noninferior to EFV
• Fewer drug-related
adverse events and
lipid changes than
EFV
• No food effect
• Fewer drug-drug
interactions than
PI- or NNRTI-based
regimens
• Twice-daily dosing
• Lower genetic barrier to resistance than
with boosted PI-based regimens
• No data with NRTIs other than TDF/
FTC in ART-naive patients
• Increase in creatine kinase, myopathy,
and rhabdomyolysis have been reported
• Rare cases of severe skin reactions
(including SJS and TEN) have been
reported, and systemic HSRs with rash
and constitutional symptoms, with or
without hepatitis, have been reported
CCR5 Antagonist
MVC
• Virologic response
noninferior to EFV
in post hoc analysis
of MERIT study (see
text)
• Fewer adverse effects
than EFV
• Requires viral tropism testing prior to
initiation of therapy, which results in
additional cost and possible delay in
initiation of therapy
• More MVC-treated than EFV-treated
patients discontinued therapy due to lack
of efficacy in MERIT study
• Less long-term experience in ART-
naive patients than with boosted PI- or
NNRTI-based regimens
• Limited experience with dual-NRTIs
other than ZDV/3TC
• Twice-daily dosing
• CYP3A4 substrate; dosing depends
on presence or absence of concomitant
CYP3A4 inducer(s) or inhibitor(s)
Dual-NRTI Pairs
a
ABC/3TC
• Virologic response
noninferior to
ZDV/3TC
• Better CD4 count
responses than with
ZDV/3TC
• Once-daily dosing
• Coformulation
• No food effect
• No cumulative TAM-
mediated resistance
• Potential for ABC HSR in patients with
HLA-B*5701
• Increased potential for cardiovascular
events, especially in patients with
cardiovascular risk factors
• Inferior virologic responses in patients
with baseline HIV RNA >100,000
copies/mL when compared with TDF/
FTC in ACTG 5202 study. However,
this was not seen in the HEAT study.
a
Agents listed in alphabetical order.
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