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Massive Change in U.S. Treatment Guidelines

January 2010

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What Not to Use

As with previous guidelines, the panel added to a growing list of drugs or combinations of drugs that should not be used for the initial therapy of HIV infection. In general, specific combinations are not recommended because of insufficient efficacy, drug interactions or insufficient information on how they work in people who have not previously used these medicines.


Modern Monotherapy

In recent years, there have been several studies of just one active drug (such as the use of a ritonavir-boosted protease inhibitor) in a regimen for maintenance therapy. That is, in clinical trials, a conventional triple-drug regimen is used to suppress viral load and raise CD4+ counts for one year, then participants are switched to one of these simple regimens for maintenance:

  • atazanavir-ritonavir
  • darunavir-ritonavir
  • lopinavir-ritonavir

These regimens are being studied in clinical trials and are considered investigational and therefore not recommended by the panel.

Other combinations that are not recommended by the panel include the following:

  • atazanavir + indinavir; increased toxicity
  • ddI + d4T; increased toxicity
  • d4T + AZT; reduced anti-HIV activity
  • any two non-nukes; increased toxicity
  • FTC + 3TC; may interfere with each other
  • etravirine and unboosted protease inhibitors; inadequate levels of the protease inhibitors may occur
  • etravirine and ritonavir-boosted atazanavir or fosamprenavir; inadequate drug concentrations may occur
  • etravirine and ritonavir-boosted tipranavir; inadequate etravirine levels may result
  • nevirapine -- initiating therapy with this drug in women whose CD4+ counts are greater than 250 cells or in men whose CD4+ counts are greater than 400 cells should not be done (because of a risk of life-threatening side effects) unless "the benefit clearly outweighs the risk"
  • unboosted darunavir, saquinavir or tipranavir; inadequate drug levels will occur
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
Read the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
More News and Analysis on HIV Treatment Guidelines


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