Adapted from Adult Treatment Guidelines Table 6: Antiretroviral Therapy for Treatment-Naive Patients (Updated November 3, 2008)
Patients naive to antiretroviral therapy should be started on a combination regimen that consists of either: 1 NNRTI + 2 NRTIs or 1 PI (preferably boosted with ritonavir) + 2 NRTIs |
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NNRTI Options |
Population in which to avoid or use with caution |
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Preferred |
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Efavirenz |
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Do not use during 1st trimester of pregnancy or in those with high pregnancy potential |
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Use with caution in patients with unstable psychiatric disease |
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Alternative |
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Nevirapine |
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Do not use in patients with moderate to severe hepatic impairment (Child-Pugh score B or C) |
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Do not use in women with pre-ARV CD4 >250 or in men with pre-ARV CD4 >400 |
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Use with caution in patients on tenofovir/emtricitabine (or lamivudine). Early virologic failure has been reported with this combination. |
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PI Options |
Population in which to avoid or use with caution |
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Preferred (alphabetical order) |
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Atazanavir + ritonavir (1x/day) |
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Do not use in patients who require high-dose (>20mg omeprazole equivalent/day) proton pump inhibitors (PPIs) |
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Darunavir +ritonavir (1x/day) |
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Fosamprenavir + ritonavir (2x/day) |
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Lopinavir/ritonavir (1x or 2x/day) |
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Do not use lopinavir/ritonavir in pregnant women |
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Alternative (alphabetical order) |
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Atazanavir (unboosted)(1x/day) |
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Do not use atazanavir in combination with tenofovir or didanosine/lamivudine |
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Fosamprenavir + ritonavir (1x/day) or fosamprenavir unboosted (2x/day) |
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Saquinavir + ritonavir (2x/day) |
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Dual-NRTI Options |
Population in which to avoid or use with caution |
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Preferred |
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Emtricitabine/tenofovir |
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Do not use in combination with unboosted atazanavir |
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Use with caution: |
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with nevirapine due to reports of early virologic failure |
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in patients with underlying renal insufficiency |
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Alternative |
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Abacavir/lamivudine |
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Do not use in patients who test positive for HLAB*5701 |
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Use with caution in the presence of the following: |
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HIV RNA >100,000 copies/mL - higher rate of virologic failure reported in ACTG 5205 |
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High risk for cardiovascular disease |
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Didanosine + lamivudine (or emtricitabine) |
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Do not use in combination with unboosted atazanavir |
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Do not use in patients with a history of pancreatitis or peripheral neuropathy |
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Zidovudine/lamivudine |
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Do not use in combination with unboosted atazanavir |
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Do not use in patients with a history of pancreatitis or peripheral neuropathy |
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Use with caution in the presence of pretreatment anemia and/or neutropenia (may improve or worsen with zidovudine) |
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