Individualization of antiretroviral therapy

Figures & data

Figure 1 Timeline of antiretrovirals.

NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.

Abbreviations:

Figure 2 Individualized antiretroviral prescription.

Abbreviation: CNS, central nervous system; CCR5, C-C Chemokine receptor type 5; AIDS, acquired immune deficiency syndrome; HLA, human leukocyte antigen; ADME, absorption distribution, metabolism and excretion.

Table 1 Comparison of recommendations on when to start, based on CD4+ cell count

	CD4 <200/μL	CD4 200–350/μL	CD4 350–500/μL	CD4 >500/μL
Department of Health and Human Services 2011^Citation1	✓	✓	✓	✓ (optional)
International AIDS Society 2010^Citation2	✓	✓	✓	Consider
European AIDS Clinical Society 2009^Citation3	✓	✓	Select only	Deferral
World Health Organization 2010^Citation4	✓	✓	✕	✕

Abbreviation: AIDS, acquired immune deficiency syndrome.

Table 2 What to start for HIV treatment naive patients – DHHS guidelines 2011

Preferred regimens	EFV or	}+ TDF/FTC
	ATV)/r or
	DRV/r or
	RAL
	Pregnant Women: LPV/r (twice daily)++ ZDV/3TC
Alternative regimens^Table Footnote*	EFV + ABC or ZDV/3TC
	NVP + ZDV/3TC
	ATV/r + (ABC or ZDV)/3TC
	FPV/r (once or twice daily) + either (ABC or ZDV)/3TC or TDF/FTC
Acceptable regimens	EFV + ddi + (3TC or FTC)
	ATV + (ABC or ZDV)/3TC
	MVC + ZDV/3TC
Data lacking	MVC + either ABC/3TC or TDF/FTC
	RAL + (ABC/ZDV) /3TC
	DRV/r or SQV/r + (ABC or ZDV)/3TC

* as of August 2011, rilpivirine, a second generation non-nucleoside reverse transcriptase inhibitor has now been approved for second-line use in combination ART in treatment naive patient¹

+ Once daily LPV/r (800/200 mg) is not recommended in pregnancy. Based on published pharmacokinetic studies it is generally recommended that the dose of LPV/r be increased to 600 mg/150 mg p.o. bid for the second and third trimesters.

Abbreviations: EFV, efavirenz; ATV, atazanavir; r, ritonavir; DRV, darunavir; TDF, tenofovir; FTC, emtricitibine; RAL, raltegravir; LPV, lopinavir; ZDV, zidovudine; 3TC, laminudine; ABC, abacavir; NVP, nevirapine; FPV, fosamprenavir; TDF, tenofovir; ddi, didanosine; MVC, maraviroc; RAL, raltegravir; SQV, saquinavir; DHHS, Department of Health and Human Services.

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