26
Selecting a Treatment Regimen
Presence of Other
Conditions
Chronic kidney
disease (defined as
CrCl <60 mL/min)
• Avoid TDF. Use ABC or TAF.
• ABC may be used if HLA-B*5701
negative.
• If HIV RNA >100,000 copies/mL,
do NOT use ABC/3TC + (EFV or
ATV/r).
• TAF may be used if CrCl >30 mL/min.
• Consider avoiding ATV.
Other Options When ABC or TAF
Cannot be Used:
• LPV/r + 3TC; or
• RAL + DRV/r (if CD4 count >200
cells/mm
3
, HIV RNA <100,000
copies/mL)
Liver disease with
cirrhosis
Some ARVs are contraindicated or may
require dosage modification in patients
with Child-Pugh class B or C disease.
Osteoporosis • Avoid TDF.
• Use ABC or TAF.
• ABC may be used if HLA-B*5701
negative.
• If HIV RNA >100,000 copies/mL,
do NOT use ABC/3TC + (EFV or
ATV/r).
Psychiatric illnesses • Consider avoiding EFV- and RPV-
based regimens.
• Patients on INSTI-based regimens
with pre-existing psychiatric conditions
should be closely monitored.
HIV-associated
dementia (HAD)
• Avoid EFV-based regimens if possible.
• Favor DRV- or DTG-based regimens.
Narcotic replacement
therapy required
• If patient is receiving methadone,
consider avoiding EFV-based regimens.
• If EFV is used, an increase in
methadone dose may be necessary.
High cardiac risk
• DTG-, RAL- or RPV-based regimens
may be advantageous in this setting.
• Consider avoiding ABC- and LPV/r-
based regimens.
• If a boosted PI is the desired option,
an ATV-based regimen may have
advantages over a DRV-based regimen.
Table 7. Antiretroviral Regimen Considerations as Initial
Therapy based on Specific Clinical Scenarios (cont'd)
Patient or
Regimen
Characteristics Clinical Scenario Consideration(s)
