New to the Game?
Current DHHS treatment guidelines for first time therapy*
Patients naïve to antiretroviral therapy should be started on one of the following three types of combination regimens:
- NNRTI + 2 NRTIs; or
- PI (preferably boosted with ritonavir) + 2 NRTIs; or
- INSTI + 2 NRTIs
| 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)/3TC 3 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)/3TC 3] or Truvada (emtricitabine/tenofovir) 3 Kaletra (LPV/r) (once or twice daily) + either Epzicom or Combivir [(ABC or ZDV)/3TC 3] or Truvada (emtricitabine/tenofovir) 3 Boosted Invirase (SQV/r) + Truvada (emtricitabine/tenofovir) 3 |
Visit www.aidsinfo.nih.gov for the complete set of guidelines and for more detailed information, including “acceptable regimens,” “regimens that may be acceptable, but more definitive data are needed,” and “regimens to be used with caution.”
- 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
ABC = abacavir, ATV = atazanavir, 3TC = lamivudine, ddI = didanosine, DRV = darunavir, EFV =efavirenz, FPV = fosamprenavir, FTC = emtricitabine, LPV = lopinavir, NVP = nevirapine, RAL = raltegravir, r = low dose ritonavir, SQV = saquinavir, TDF = tenofovir, ZDV = zidovudine
* 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. December 1, 2009; 1-161. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed January 25, 2010; page 39; Table 5a
