POSITIVELY AWARE March/April 2012
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Standard practice
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. October 14, 2011; 1-167; available here. Accessed February 21, 2012; page 43; Table 5a.
Patients new to antiretroviral therapy
should start on one of three types of combination regimens:
| PREFERRED REGIMENS | |
| NNRTI-BASED | Sustiva (EFV)1 + Truvada (TDF/FTC)3 |
| PI-BASED | Boosted Prezista (DRV/r) + Truvada (TDF/FTC)3 |
| INSTI-BASED | Isentress (RAL) + Truvada (TDF/FTC)3 |
| PREFERRED FOR PREGNANT WOMEN | |
| PI-BASED | Kaletra (LPV/r) (twice daily) + Combivir (ZDV/3TC)3 |
| ALTERNATIVE REGIMENS | |
| NNRTI-BASED | Edurant (RPV) + Epzicom or Truvada (TDF/FTC)3 |
| PI-BASED | Kaletra (LPV/r) (once or twice daily) + Epzicom (ABC/3TC)3 or Truvada (TDF/FTC)3 |
| INSTI-BASED | Isentress (RAL) + Epzicom (ABC/3TC)3 |
| ACCEPTABLE REGIMENS | |
| NNRTI-BASED | Edurant (RPV) + Combivir (ZDV/3TC)3 Sustiva (EFV) + Combivir (ZDV/3TC)3 Viramune (NVP)2 + Combivir or Epzicom or Truvada |
| PI-BASED | Kaletra (LPV/r) + Combivir (ZDV/3TC)3 |
| CCR5 Antagonist-based regimens | Selzentry (MVC) + Combivir (ZDV/3TC)3 |
| MAY BE ACCEPTABLE, BUT MORE DATA NEEDED | |
| CCR5 Antagonist-based regimens | Selzentry (MVC) + Truvada (TDF/FTC)3 or Epzicom or Combivir (ABC or ZDV/3TC)3 |
| MAY BE ACCEPTABLE, BUT USE WITH CAUTION | |
| PI-based regimens | Boosted Invirase (SQV/r) + Epzicom or Combivir (ABC or ZDV/3TC)3 |
- 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.
- 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
