Antiretroviral drug regimens that should not be offered at any time are shown in Table 8.
Table 8. Antiretroviral drug regimens that should not be offered at any time (see the DHHS guidelines for exceptions[2])
|
Antiretroviral drug regimen |
Rationale |
|
Monotherapy with NRTIs |
Inferior virological activity plus rapid development of resistance |
|
Dual-NRTI regimens |
Inferior virological activity plus rapid development of resistance. |
|
Triple-NRTI regimens |
High rate of early virological nonresponse. |
|
Nevirapine in ART-naïve women and men with CD4+ T cell counts ≥ 250 cells/μL and 400 cells/μL, respectively |
Greater risk of severe, life-threatening hepatotoxicity |
|
Unboosted saquinavir, darunavir or tipranavir |
Inadequate bioavailability |
|
Nevirapine + efavirenz, or nevirapine/ efavirenz/ etravirine |
Higher incidence of toxicity and similar resistance profiles |
|
Emtricitabine + lamivudine |
Similar resistance profiles, no potential benefit |
|
Etravirine + unboosted PI |
ETR may induce metabolism of PIs; appropriate doses not yet established |
|
Etravirine + ritonavir-boosted atazanavir or fosamprenavir |
ETR may alter the concentrations of these PIs; appropriate doses not yet established |
|
Etravirine + ritonavir-boosted tipranavir |
ETR concentration may be significantly reduced by ritonavir -boosted TPV |