5
Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial ART
ARV
Class
ARV
Agent(s) Advantages Disadvantages
Dual-
NRTI
ABC/3TC • Coformulated with
DTG
• May cause life-threatening
hypersensitivity reaction
(HSR) in patients positive for
the HLA-B*5701 allele. As a
result, HLA-B*5701 testing
required before use.
• In the ACTG 5202 study,
patients with baseline HIV
RNA ≥100,000 copies/mL
showed inferior virologic
responses when ABC/3TC
was given with EFV or ATV/r
as opposed to TDF/FTC.
This difference was not seen
when ABC/3TC was used in
combination with DTG.
• ABC use has been associated
with CV disease and cardiac
events in some, but not all,
observational studies.
TAF/FTC • Coformulated with
EVG/c or RPV
• Active against HBV; a
recommended dual-NRTI
option for patients with
HIV/HBV coinfection
• Smaller decline in renal
function, less proteinuria,
and smaller reductions in
BMD than after initiation
of TDF/FTC
• Approved for patients
with eGFR ≥30 mL/min
• TDF is associated with lower
lipid levels than TAF, perhaps
because TDF results in higher
plasma levels of tenofovir,
which lowers lipids.
TDF/FTC • Coformulated with EFV,
EVG/c, and RPV as single-
tablet regimens (STRs)
• Active against HBV; a
recommended dual-NRTI
for patients with HIV/
HBV coinfection
• Better virologic responses
than with ABC/3TC in
patients with baseline viral
load ≥100,000 copies/mL
when combined with
ATV/r or EFV
• Associated with lower
lipid levels than ABC
or TAF
• Renal toxicity, including
proximal tubulopathy
and acute or chronic renal
insufficiency.
• Osteomalacia has been
reported as a consequence of
proximal tubulopathy.
• Decreases BMD more than
other NRTI combinations.
