3
ese regimens are effective and tolerable, but have some disadvantages when compared
with the regimens listed in Table 1a, or have less supporting data from randomized
clinical trials. However, in certain clinical situations, one of these regimens may be
preferred.
Boosted PI + 2-NRTIs: (In general, boosted DRV is preferred over boosted ATV)
Î (DRV/c or DRV/r) + tenofovir
b
/FTC
a
(A-I for DRV/r and A-II for DRV/c)
Î (ATV/c or ATV/r) + tenofovir
b
/FTC
a
(B-I)
Î (DRV/c or DRV/r) + ABC/3TC
a
(B-II if HLA-B*5701 negative)
Î (ATV/c or ATV/r) + ABC/3TC
a
(If HLA-B*5701 negative and HIV RNA
<100,000 copies/mL: C-II for ATV/r and C-III for ATV/c)
NNRTI + 2 NRTIs:
Î EFV+ tenofovir
b
/FTC
a
(B-I for EFV/TDF/FTC and B-II for EFV + TAF/FTC)
Î RPV/tenofovir
b
/FTC
a
(B-I if HIV RNA <100,000 copies/mL and
CD4 cell count >200 cells/mm
3
)
INSTI + 2 NRTIs:
Î RAL
c
+ ABC/3TC
a
(C-III if HLA-B*5701 negative and HIV RNA <100,000
copies/mL)
Regimens to consider when ABC, TAF and TDF cannot be used
d
:
Î DRV/r + RAL (bid) (C-I if HIV RNA <100,000 copies/mL and
CD4 >200 cells/mm
3
Î LPV/r + 3TC
a
(bid)
e
(C-I)
a
3TC may be substituted for FTC, or vice versa, if a non–fixed-dose NRTI combination is desired.
b
TAF and TDF are two forms of tenofovir approved by the FDA. TAF has fewer bone and kidney
toxicities than TDF, while TDF is associated with lower lipid levels. Safety, cost, and access are
among the factors to consider when choosing between these drugs.
c
RAL can be given as 400 mg bid or 1200 mg (two 600-mg tablets) once daily.
d
Several other NRTI-limiting treatment strategies are under investigation. See the section titled
Selected Strategies at Are Under Evaluation and Not Yet Recommended for discussion regarding
these regimens at http://aidsinfo.nih.gov/guidelines.
e
LPV/r plus 3TC is the only boosted PI plus 3TC regimen with published 48-week data in a
randomized controlled trial in ART-naive patients. Limitations of LPV/r plus 3TC include twice-
daily dosing, high pill burden, and greater rates of GI side effects than other PIs.
Note: e following are available as coformulated drugs: ABC/3TC, ATV/c, DRV/c, DTG/ABC/3TC,
EFV/TDF/FTC, EVG/c/TAF/FTC, EVG/c/TDF/FTC, LPV/r, RPV/TAF/FTC, RPV/TDF/FTC,
TAF/FTC, and TDF/FTC.
Table 1b. Recommended Initial Regimens in Certain Clinical
Situations
