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Keeping Standards: Current DHHS Treatment Guidelines for First-Time Therapy

March/April 2013

A regimen should be individualized on the basis of virologic efficacy (suppression of viral load to less than 50 copies per mL), toxicity, pill burden, dosing frequency, drug-drug interaction potential, drug resistance testing results, and co-morbid conditions (such as kidney disease, hepatitis B or C, etc.). See details about the strength of the recommendations in the DHHS documents online.

Index of abbreviations

Patients new to antiretroviral therapy should start on one of three types of combination regimens:


graphic depicting an NNTRI-Based Regimen, a PI-based regimen, and an INSTI-baes regimen


Preferred Regimens
NNRTI-based Atripla (EFV1/FTC/TDF)3
PI-based

Boosted Prezista (DRV/r) (once daily) + Truvada (FTC/TDF)3
Boosted Reyataz (ATV/r) + Truvada (FTC/TDF)3

INSTI-based Isentress (RAL) + Truvada (FTC/TDF)3
Preferred for Pregnant Women
PI-based Kaletra (LPV/r) (twice daily) + Combivir (3TC/ZDV)3
boosted Reyataz (ATV/r) (once daily) + Combivir (3TC/ZDV)3
Alternative Regimens
Based on personal characteristics and needs, in some instances, an alternative regimen may actually be a preferred regimen for an individual.
NNRTI-based

Complera (RPV/FTC/TDF)3
Edurant (RPV) + Epzicom (ABC/3TC)3,4
Sustiva (EFV1 ) + Epzicom (ABC/3TC)3,4

PI-based

Kaletra (LPV/r) (once or twice daily) + Epzicom (ABC/3TC)3,4 or Truvada (TDF/FTC)3
Boosted Lexiva (FPV/r) (once or twice daily) + Epzicom (ABC/3TC)3,4 or Truvada (FTC/TDF)3
Boosted Prezista (DRV/r) + Epzicom (ABC/3TC)3,4
Boosted Reyataz (ATV/r) + Epzicom (ABC/3TC)3,4

INSTI-based Isentress (RAL) + Epzicom (ABC/3TC)3,4
Stribild (EVG/COBI/FTC/TDF)
Other Antiretroviral Regimens
Regimens that may be selected for some patients but are less satisfactory than preferred or alternative regimens.
NNRTI-based Edurant (RPV) + Combivir (3TC/ZDV)3
Sustiva (EFV) + Combivir (3TC/ZDV)3
Viramune (NVP2) + Combivir (3TC/ZDV)3 or Epzicom (ABC/3TC)3,4 or Truvada (FTC/TDF)3
PI-based

boosted Invirase (SQV/r) + Combivir (3TC/ZDV)3, or Epzicom (ABC/3TC)3,4 or Truvada (FTC/TDF)3,
Kaletra (LPV/r) + Combivir (3TC/ZDV)3
Boosted Lexiva (FPV/r) + Combivir (3TC/ZDV)3
Boosted Prezista (DRV/r) + Combivir (3TC/ZDV)3
Boosted Reyataz (ATV/r) + Combivir (3TC/ZDV)3
Reyataz (ATV) + Combivir (3TC/ZDV)3 or Epzicom (ABC/3TC)3,4

INSTI-based Isentress (RAL) + Combivir (3TC/ZDV)3
CCR5 Antagonist-based regimen

Selzentry (MVC)5 + Combivir (3TC/ZDV)3 or Epzicom (ABC/3TC)3,4 or Truvada (FTC/TDF)3

  1. Except during first trimester of pregnancy or in women with high pregnancy potential.
  2. 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.
  3. Emtriva (emtricitabine) and Epivir (lamivudine) are interchangeable.
  4. ABC should not be used in people who test positive for HLA-B*5701.
  5. MVC may be considered in people who have only CCR5-tropic HIV.


Sources

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. Section accessed February 6, 2013; Tables 5a and 5b.

Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Accessed February 6, 2013; Table 5.


Drug Class Abbreviations

  • INSTI = integrase strand transfer inhibitor
  • NNRTI = non-nucleoside reverse transcriptase inhibitor
  • NRTI = nucleos(t)ide reverse transcriptase inhibitor
  • PI = protease inhibitor


Generic Name Abbreviations

  • 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


These Combinations Are Among Those Available as Co-Formulated Fixed-Dose Combinations

  • EFV/FTC/TDF (Atripla)
  • 3TC/ZDV (Combivir)
  • RPV/FTC/TDF (Complera)
  • ABC/3TC (Epzicom)
  • LPV/r (Kaletra)
  • EVG/COBI/FTC/TDF (Stribild)
  • FTC/TDF (Truvada)


This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
See Also
More on HIV Treatment Guidelines: HIV Texts & Guides for Adults & Adolescents

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