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Table 1. Initial Antiretroviral Regimens
Recommended Components of Initial ART
To construct a regimen, choose 1 NNRTI or PI component from column A and 1 dual-NRTI combination from column B
Preferred
Components
Alternative
Components
NNRTI
efavirenza •
NNRTI
nevirapinec •
Section 3—Antiretroviral Therapy | 3–5
Column A: NNRTI or PI Options Column B: Dual-NRTI Options
or PI
•
•
•
or PI
•
•
•
•
atazanavir + ritonavir
fosamprenavir + ritonavir (BID)
lopinavir/ ritonavir (BID)
atazanavir d
fosamprenavir
fosamprenavir + ritonavir (QD)
lopinavir/ ritonavir (QD)
+
+
Preferred
Components
Alternative
Components
tenofovir/ emtricitabineb •
• zidovudine/ lamivudine
• abacavir/ lamivudine
• didanosine + (emtricitabine
or lamivudine)
Key to abbreviations: ART = antiretroviral therapy; BID = twice daily; NNRTI = nonnucleoside reverse transcriptase inhibitor; NRTI = nucleoside/nucleotide analogue; PI = protease inhibitor; QD=once daily.
a. Efavirenz is not recommended for use in the 1st trimester of pregnancy or in sexually active women with childbearing potential who are not using effective contraception.
b. Emtricitabine may be used in place of lamivudine and vice versa.
c. Nevirapine should not be initiated in women with CD4 cell count >250 cells/µL or in men with CD4 cell count >400 cells/µL because of increased risk of hepatotoxicity.
d. Atazanavir must be boosted with ritonavir if used in combination with tenofovir.
Adapted from U.S. Department of Health and Human Services. Table 6a. Antiretroviral Components Recommended for Treatment of HIV-1 Infection in Treatment Naive Patients.
In: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. October 10, 2006.
Acquired or “primary” resistance, in which a patient is
infected with ARV-resistant virus, is common in parts
of the United States. Because both multi- and singleclass
resistance has been found among drug-naive
persons in many U.S. cities, it is recommended that
individuals with newly diagnosed HIV infection and
those new to care should receive a baseline resistance
test as early as possible, and before initiation of ART
(see chapter Resistance Testing).
Drug Interactions
Many of the ARVs interact with one another as well
as with other common medications. When starting
or changing an ARV regimen, review all the patient’s
current medications carefully for possible drug
interactions. See chapter Drug-Drug Interactions with
HIV-Related Medications for a summary of this issue
and for references and resources to review medication
lists and combinations. For further information on drug
interactions involving ARVs, see Tables 20, and 22a-c,
and 21a-b in the Adult and Adolescent ARV Guidelines.
Once-Daily Regimens
Convenient and simplified dosing is an obvious
strategy to improve adherence, particularly with the
availability of coformulations that reduce pill burden
(see “Preferred Starting Regimens,” above). The Adult
and Adolescent ARV Guidelines currently include 2 oncedaily
combinations among “preferred” regimens, and list
several other possibilities as “alternative” regimens.
The combinations indicated below (2 NRTIs + 1
NNRTI or PI) are likely to be effective in initial therapy
(Table 2). Some of these combinations, however, have
not been studied in clinical trials.
Table 2. Once-Daily Regimens for Initial Therapy
NRTI Combinations NNRTI or PI
•
•
•
•
Lamivudine or emtricitabine + abacavir
Lamivudine or emtricitabine + didanosine
Lamivudine or emtricitabine + tenofovir #
Didanosine + tenofovir* #
•
•
•
•
•
•
Efavirenz*
Nevirapine* ^
Atazanavir #
Atazanavir/ritonavir
Fosamprenavir/
ritonavir
Lopinavir/ritonavir
Key to abbreviations: NRTI = nucleoside reverse transcriptase inhibitor; NNRTI = nonnucleoside reverse
transcriptase inhibitor; PI = protease inhibitor.
* Didanosine + tenofovir should not be used with efavirenz or nevirapine.
^ Nevirapine is not FDA approved for once-daily dosing.
# Tenofovir cannot be used with unboosted atazanavir. Adapted from Coffey S. Options for Once-
Daily Dosing of Antiretrovirals. AETC National Resource Center Web site. Available at http://aidsetc.
org/aidsetc?page=et-03-00-01.