6
Selecting a Treatment Regimen
Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial ART (cont'd)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
INSTI DTG • Higher barrier to
resistance than EVG
or RAL
• Coformulated with
ABC and 3TC
• No food requirement
• No CYP3A4
interactions
• Favorable lipid
profile
• Oral absorption can be reduced
by simultaneous administration
with products containing
polyvalent cations (e.g., Al-,
Ca-, or Mg-containing antacids
or supplements, or multivitamin
tablets with minerals).
• Inhibits renal tubular secretion
of Cr and can increase serum Cr
without affecting glomerular
function.
• UGT substrate; potential for
drug interactions
• Depression and suicidal
ideation (rare; usually in
patients with preexisting
psychiatric conditions).
EVG/c • Coformulated with
TDF/FTC or
TAF/FTC
• Compared with
ATV/r, causes
smaller increases
in total and LDL
cholesterol
• EVG/c/TDF/FTC is
recommended only for patients
with baseline CrCl ≥70 mL/
min. This regimen should be
discontinued if CrCl decreases
to <50 mL/min.
• COBI is a potent CYP3A4
inhibitor, which can result in
significant interactions with
CYP3A substrates.
• Oral absorption of EVG can
be reduced by simultaneous
administration with products
containing polyvalent cations
(eg, Al-, Ca-, or Mg-containing
antacids or supplements, or
multivitamin tablets with
minerals).
• COBI inhibits active tubular
secretion of Cr and can increase
serum Cr without affecting renal
glomerular function.
• Lower genetic barrier to
resistance than boosted PI- or
DTG-based regimens.
• Food requirement.
• Depression and suicidal ideation
(rare; usually in patients
with preexisting psychiatric
conditions).
