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• TDF has been associated with proximal renal tubulopathy. Higher rates of renal
dysfunction reported in patients using TDF in conjunction with RTV-containing
regimens.
• TAF has less impact on renal function and lower rates of proteinuria than TDF.
• ATV has been associated with chronic kidney disease in some observational
studies.
• ABC has not been associated with renal dysfunction.
• See Table 6 for recommendations on ARV dose modification in patients with renal
insufficiency.
• Refer to Table 6 for specific dosing recommendations.
• Patients with cirrhosis should be carefully evaluated by an expert in advanced liver
disease.
• TDF is associated with decreases in bone mineral density along with renal
tubulopathy, urine phosphate wasting and resultant osteomalacia.
• TAF and ABC are associated with smaller declines in bone mineral density than
TDF.
• EFV and RPV can exacerbate psychiatric symptoms and may be associated with
suicidality.
• INSTIs have been associated with adverse neuropsychiatric effects in some
retrospective cohort studies and case series.
• EFV-related neuropsychiatric effects may confound assessment of ART's beneficial
effects on improvement of HAD-related symptoms.
• There is a theoretical CNS penetration advantage of DTG- or DRV-based regimens.
EFV reduces methadone concentrations and may lead to withdrawal symptoms.
• An increased CV risk has been observed in some studies.
• Observational cohort studies reported an association between some PIs (DRV,
IDV, FPV, and LPV/r) and an increased risk of CV events, while this has not been
seen with ATV. Further study is needed.
Rationale/Comments
