8
Selecting a Treatment Regimen
NNRTIs
(cont'd)
RPV • Coformulated with
TDF/FTC and
TAF/FTC.
• RPV/TDF/FTC
and RPV/TAF/
FTC have smaller
pill size than other
coformulated ARV
drugs.
• Compared with
EFV:
▶ Fewer CNS
adverse effects
▶ Fewer lipid effects
▶ Fewer rashes
• NOT recommended in patients
with pre-ART HIV RNA
>100,000 copies/mL or CD4
count <200 cells/mm
3
because of
higher rate of virologic failure in
these patients.
• Depression and suicidality
• QTc interval prolongation;
consider an alternative to RPV in
patients taking medications with
known risk of causing TdP, or in
those at higher risk of TdP.
• Rash.
• Transmitted resistance more
common than with PIs and
INSTIs.
• More NNRTI-, TDF-, and 3TC-
associated mutations at virological
failure than with regimen
containing EFV and two NRTIs.
• Potential for CYP450 drug
interactions.
• Food requirement (>390 kcal).
• Requires acid for adequate
absorption.
▶ Contraindicated with PPIs
▶ Use with H2 antagonists or
antacids with caution
PIs ATV/c or
ATV/r
• Higher genetic
barrier to resistance
than NNRTIs, EVG,
and RAL.
• PI resistance at the time
of treatment failure
uncommon with PK-
enhanced PIs.
• ATV/c and ATV/r
have similar virologic
activity and toxicity
profiles.
• Observational cohort
studies have found an
association between
some PIs (DRV,
LPV/r, FPV, IDV)
and an increased risk
of CV events, while
this has not been seen
with ATV. Further
study is needed.
• Commonly causes indirect
hyperbilirubinemia, which may
manifest as scleral icterus or
jaundice.
• Food requirement.
• Absorption depends on food
and low gastric pH.
• Nephrolithiasis, cholelithiasis,
nephrotoxicity.
• GI adverse effects.
• CYP3A4 inhibitors and
substrates: potential for drug
interactions.
Table 2. Advantages and Disadvantages of Antiretroviral
Components Recommended as Initial ART (cont'd)
ARV
Class
ARV
Agent(s) Advantages Disadvantages
