Selecting a Treatment Regimen
Table 4. Antiretroviral Regimens or Components That Should NOT Be Offered At Any Time (Updated October 2011)
ARV Drugs or Components (in alphabetical order)
ABC/3TC/ZDV (coformulated) as triple- NRTI combination regimen (BI)
ABC + 3TC + ZDV + TDF as quadruple-NRTI combination (BI)
ABC + ddI (BIII) ABC + TDF (BIII) d4T + 3TC (BI)
recommending as initial therapy Reasons for NOT ▶ Inferior virologic efficacy ▶ Inferior virologic efficacy
▶ Insufficient data in ART-naïve patients ▶ Insufficient data in ART-naïve patients
▶ Significant toxicities including lipoatrophy; peripheral neuropathy; and hyperlactatemia, including symptomatic and life-threatening lactic acidosis, hepatic steatosis, and pancreatitis
ddI + 3TC (or FTC) (BIII) ▶ Inferior virologic efficacy, least clinical trial experience ddI + TDF (BII)
▶ Increased ddI drug exposure and toxicities DLV (BII)
DRV (unboosted) ENF (BIII)
ETR (BIII) FPV (unboosted) (BIII) IDV (unboosted) (BIII)
▶ Inferior virologic efficacy ▶ Inconvenient (three times daily) dosing
▶ Use without RTV has not been studied
▶ No clinical trial experience in ART-naïve patients ▶ Requires twice-daily subcutaneous injections
▶ Insufficient data in ART-naïve patients
▶ Less potent than RTV-boosted FPV ▶ Virologic failure with unboosted FPV-based regimen may select mutations that confer resistance to DRV
▶ Inconvenient dosing (three times daily with meal restrictions)
▶ Fluid requirement
IDV (RTV-boosted) (BIII) ▶ High incidence of nephrolithiasis NFV (BI)
▶ Inferior virologic efficacy ▶ High incidence of diarrhea
RTV as sole PI (BIII) SQV (unboosted) (BI)
TPV (RTV-boosted) (BI) 6
▶ High pill burden ▶ Gastrointestinal intolerance
▶ Inferior virologic efficacy ▶ Inferior virologic efficacy
▶ High rate of early virologic failure ▶ Rapid selection of resistance mutations ▶ Potential for immunologic nonresponse/CD4 T-cell decline
