Table 3. Antiretroviral Regimens for Antiretroviral Therapy- Naïve Patients (Updated October 2011) (cont'd)
Regimens That May Be Acceptable But More Definitive Data Are Needed + ABCf
NNRTI-Based Regimen Î NVPh, k
Î RPVg +ZDVe (CIII) + (TDF/FTCb /3TCb (CIII) /3TCb (CIII)
CCR5 Antagonist-Based Regimen Î MVCj
or ABCf /3TCb )
INSTI-Based Regimen Î RAL + ZDVe
/3TCb
PI-Based Regimens Î DRV/r + ZDVe
(CIII) /3TCb (CIII)
Regimens That May Be Acceptable But Should Be Used With Caution (Regimens that have demonstrated virologic efficacy in some studies, but have safety, resistance, or efficacy concerns.)
PI-Based Regimen Î SQV/r l
Î SQV/r l a
+ TDF/FTCb (CI) + (ABCf
or ZDVe )/3TCb (CIII)
EFV should NOT be used during the first trimester of pregnancy or in women trying to conceive or not using effective and consistent contraception. b 3TC may substitute for FTC or vice versa.
c ATV/r should NOT be used in patients who require > 20 mg omeprazole equivalent per day. d Once-daily LPV/r is NOT recommended in pregnant women.
e f
g RPV must be taken with a meal. It is contraindicated in patients taking proton-pump inhibitors (PPIs); use with caution with H2
h with plasma HIV RNA > 100,000 copies/mL.
i ATV/r is generally preferred over ATV. Unboosted ATV may be used when ritonavir boosting is not possible. j
NVP should NOT be used in patients with moderate to severe hepatic impairment (Child-Pugh B or C). NVP should NOT be used in women with pre-ARV CD4 > 250 cells/mm3 pre-ARV CD4 > 400 cells/mm3
. k l -receptor antagonists and antacids. Use with caution in patients or men with
With MVC, tropism testing is required before treatment. Only patients found to have only CCR5- tropic virus are candidates for MVC.
• SQV/r was associated with PR and QT prolongation in a healthy volunteer study. • Baseline ECG is recommended before initiation of SQV/r. • SQV/r is NOT recommended in patients with any of the following: 1. pretreatment QT interval > 450 msec 2. refractory hypokalemia or hypomagnesemia 3. concomitant therapy with other drugs that prolong QT interval 4. complete AV block without implanted pacemaker 5. risk of complete AV block
Use NVP and ABC together with caution because both can cause hypersensitivity reactions within first few weeks after initiation of therapy.
ABC should NOT be used in patients who test positive for HLA-B*5701. Use with caution in patients with high risk of cardiovascular disease or with pretreatment HIV-RNA > 100,000 copies/mL.
ZDV can cause bone marrow suppression, lipoatrophy, and rarely lactic acidosis with hepatic steatosis.
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