POSITIVELY AWARE MARCH/APRIL 2011
The rules of the game
Current DHHS treatment guidelines for first time therapy*
* Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. January 10, 2011; 1-166. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed January 25, 2011; page 39; Table 5a.
Patients new to antiretroviral therapy should start on one of three types of combination regimens:
| PREFERRED REGIMENS | |
| NNRTI-BASED | |
| Sustiva (efavirenz) 1 + Truvada (emtricitabine/tenofovir) | |
| PI-BASED | |
| Boosted Reyataz (atazanavir/ritonavir) + Truvada (emtricitabine/tenofovir) Boosted Prezista (darunavir/ritonavir) + Truvada (emtricitabine/tenofovir) | |
| INSTI-BASED | |
| Isentress (raltegravir) + Truvada (emtricitabine/tenofovir) | |
| PREFERRED FOR PREGNANT WOMEN | |
| PI-BASED | |
| Kaletra (lopinavir/ritonavir) (twice daily) + Combivir (zidovudine/lamivudine) | |
| ALTERNATIVE REGIMENS | |
| NNRTI-BASED | |
| Sustiva (EFV) + Epzicom or Combivir (ABC or ZDV)/3TC3 Viramune (NVP) 2 + Combivir (ZDV/3TC) 3 |
|
| PI-BASED | |
| Boosted Reyataz (atazanavir/ritonavir) + Epzicom or Combivir (ABC or ZDV)/3TC 3 Boosted Lexiva (FPV/r (once or twice daily) + either Epzicom or Combivir [(ABC or ZDV)/3TC3] or Truvada (emtricitabine/tenofovir) 3 Kaletra (LPV/r) (once or twice daily) + either Epzicom or Combivir [(ABC or ZDV)/3TC3] or Truvada (emtricitabine/tenofovir) 3 Boosted Invirase (SQV/r) + Truvada (emtricitabine/tenofovir) 3 |
|
| ACCEPTABLE REGIMENS | |
| NNRTI-BASED | |
| Sustiva (EFV) + Videx (ddI) + (3TC or FTC) | |
| PI-BASED | |
| Reyataz (ATV) + Epzicom or Combivir (ABC or ZDV)/3TC3 | |
| CCR5 ANTAGONIST-BASED REGIMENS | |
| Selzentry (MVC) + Combivir (ZDV/3TC3) | |
| MAY BE ACCEPTABLE, BUT MORE DATA NEEDED These regimens may be acceptable, but more definitive data are needed. |
|
| PI-BASED | |
| Boosted Prezista (DRV/r) + Epzicom or Combivir (ABC or ZDV)/3TC3 | |
| INSTI-BASED | |
| Isentress (RAL) + Epzicom or Combivir (ABC or ZDV)/3TC3 | |
| CCR5 ANTAGONIST-BASED REGIMENS | |
| Selzentry (MVC) + Truvada (TDF/FTC3) or Epzicom (ABC/3TC3) | |
| MAY BE ACCEPTABLE, BUT USE WITH CAUTION These regimens may be acceptable, but should be used with caution. |
|
| NNRTI-BASED REGIMENS | |
| Viramune + Epzicom (ABC/3TC3) Viramune + Truvada (TDF/FTC3) | |
| PI-BASED REGIMENS | |
| Lexiva (FPV) + Epzicom or Combivir or Truvada [(ABC or ZDV)/3TC3 or TDF/FTC3] Boosted Invirase (SQV/r) + Truvada (TDF/FTC3) Boosted Invirase (SQV/r) + Epzicom or Combivir (ABC or ZDV)/3TC3 | |
- Except during first trimester of pregnancy or in women with high pregnancy potential
- Viramune (nevirapine) should not be initiated in women with CD4+ T-cell count greater than 250 cells/mm3 or in men with CD4+ T-cell count greater than 400 cells/mm3
- Emtriva (emtricitabine) and Epivir (lamivudine) are interchangeable.
ABBREVIATIONS:
INSTI = integrase strand transfer inhibitor, NNRTI = non-nucleoside reverse transcriptase inhibitor, NRTI = nucleos(t)ide reverse transcriptase inhibitor, PI = protease inhibitor, 3TC = lamivudine, ABC = abacavir, ATV = atazanavir, ddI = didanosine, DRV = darunavir, EFV =efavirenz, FPV = fosamprenavir, FTC = emtricitabine, LPV = lopinavir, MVC = maraviroc, NVP = nevirapine, RAL = raltegravir,
r = low dose ritonavir, SQV = saquinavir, TDF = tenofovir, ZDV = zidovudine
