25
Rationale/Comments
A higher rate of virologic failure has been observed in those with low pretreatment CD4
cell count.
Higher rates of virologic failure have been observed in those with high pretreatment
HIV RNA.
Abacavir hypersensitivity, a potentially fatal reaction, is highly associated with positivity
for the HLA-B*5701 allele.
• Transmitted mutations conferring NNRTI resistance are more likely than
mutations associated with PI or INSTI resistance.
• Resistance to DRV/r and DTG emerges slowly. Transmitted resistance to DRV
is rare and transmitted resistance to DTG has not been reported to date.
• Do NOT use RPV-based regimens if HIV RNA >100,000 copies/mL and
CD4 count <200/mm
3
.
• Since RPV-containing STRs are smaller in size than other STRs, they may be
considered when a person has difficulty swallowing a larger pill.
• Do NOT use DTG/ABC/3TC if HLA-B*5701 positive
• See Table 6 for recommendations on ARV dose modification in the setting of
renal impairment.
Oral bioavailability of these regimens is not significantly affected by food.
Food improves absorption of these listed regimens. RPV-containing regimens should be
taken with at least 390 calories of food.
Food increases EFV absorption and may increase CNS side effects.
