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Adult and Adolescent Guidelines

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Adapted from Adult Treatment Guidelines Table 6: Antiretroviral Therapy for Treatment-Naive Patients (Updated November 3, 2008)

Patients naive to antiretroviral therapy should be started on a combination regimen that consists of either: 1 NNRTI + 2 NRTIs or 1 PI (preferably boosted with ritonavir) + 2 NRTIs 
  NNRTI Options Population in which to avoid or use with caution
Preferred  
  Efavirenz Do not use during 1st trimester of pregnancy or in those with high pregnancy potential  
      Use with caution in patients with unstable psychiatric disease  
         
  Alternative      
  Nevirapine   Do not use in patients with moderate to severe hepatic impairment (Child-Pugh score B or C)   
      Do not use in women with pre-ARV CD4 >250 or in men with pre-ARV CD4 >400  
      Use with caution in patients on tenofovir/emtricitabine (or lamivudine). Early virologic failure has been reported with this combination.   
PI Options Population in which to avoid or use with caution
  Preferred (alphabetical order)      
  Atazanavir + ritonavir (1x/day)   Do not use in patients who require high-dose (>20mg omeprazole equivalent/day) proton pump inhibitors (PPIs)  
  Darunavir +ritonavir (1x/day)      
  Fosamprenavir + ritonavir (2x/day)      
  Lopinavir/ritonavir (1x or 2x/day)   Do not use lopinavir/ritonavir in pregnant women   
  Alternative (alphabetical order)      
  Atazanavir (unboosted)(1x/day)   Do not use atazanavir in combination with tenofovir or didanosine/lamivudine  
  Fosamprenavir + ritonavir (1x/day) or fosamprenavir unboosted (2x/day)      
  Saquinavir + ritonavir (2x/day)      
         
  Dual-NRTI Options Population in which to avoid or use with caution
  Preferred      
  Emtricitabine/tenofovir   Do not use in combination with unboosted atazanavir  
      Use with caution:  
with nevirapine due to reports of early virologic failure
      in patients with underlying renal insufficiency  
  Alternative      
  Abacavir/lamivudine   Do not use in patients who test positive for HLAB*5701  
      Use with caution in the presence of the following:  
      HIV RNA >100,000 copies/mL - higher rate of virologic failure reported in ACTG 5205  
      High risk for cardiovascular disease  
  Didanosine + lamivudine (or emtricitabine)   Do not use in combination with unboosted atazanavir  
      Do not use in patients with a history of pancreatitis or peripheral neuropathy  
  Zidovudine/lamivudine   Do not use in combination with unboosted atazanavir  
      Do not use in patients with a history of pancreatitis or peripheral neuropathy  
      Use with caution in the presence of pretreatment anemia and/or neutropenia (may improve or worsen with zidovudine)  
         
         
CitationBack
How to Cite the Adult and Adolescent Guidelines:
Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. November 3, 2008; pp 1-139. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed (insert date) [insert page number, table number, etc. if applicable]
Clinical TrialsBack
23 studies were listed in the last 30 days.            

RecruitingCCR5 Inhibitor Treatment Intensification on CD4+ T-Cell Recovery
Condition: HIV Infections
Not yet recruitingUniversal Use of EFV-TDF-FTC and AZT-3TC-LPV/r Combinations for HIV-1 PMTCT in Pregnant and Breastfeeding Women : a Phase 3 Trial
Condition: HIV Infection; Pregnancy; Breastfeeding
Not yet recruitingStudy of Bone Disease in Older HIV-Infected Adults
Condition: Osteopenia; Osteoporosis; HIV Infection; Aging
RecruitingNatural History Study of HIV Acquired in Infancy or Childhood
Condition: HIV
RecruitingLongitudinal Studies of HIV-Associated Lung Infections and Complications (Lung HIV)
Condition: HIV; Lung
Not yet recruitingIntensVIH: Impact Of Therapy Intensification By An Integrase Inhibitor +/- CCR5 Inhibitor On The Lymphoid Reservoir For Hiv-1 In Chronically Infected Patients
Condition: HIV Infections
Not yet recruitingHepatitis B Virus (HBV) Prevention for Homeless at Risk for HBV/Hepatitis C Virus (HCV)/HIV
Condition: Hepatitis B; Hepatitis C; HIV; HIV Infections
RecruitingTreatment of Acute HIV With Emtricitabine, Tenofovir and Efavirenz (CID 0805)
Condition: Acute HIV Infection; HIV Infections
Not yet recruitingEffect of Extra Virgin Olive Oil on Atherosclerosis Biomarkers in HIV-Infected Patients
Condition: HIV; Atherosclerosis; HIV Infections
RecruitingIntegration of HIV Care and Treatment Into Antenatal Care in Migori District, Kenya
Condition: HIV Infections
Not yet recruitingEvaluation of Three Strategies of Second-Line Antiretroviral Treatment in Africa (Dakar - Bobo-Dioulasso - Yaoundé)
Condition: HIV; HIV Infections
Not yet recruitingA Pilot Study of Pre-Exposure Prophylaxis (PrEP) to Evaluate Safety, Acceptability, and Adherence in At-Risk Populations in Uganda, Africa
Condition: HIV Infection
Not yet recruitingSwitch From Tenofovir to Raltegravir for Low Bone Mineral Density
Condition: HIV; Osteopenia; Osteoporosis
RecruitingDrug Interaction Study Between Inhaled Beclomethasone and Protease Inhibitors in Healthy Volunteers
Condition: HIV; Asthma; Pharmacokinetics; Drug Metabolism; Drug Interactions
Not yet recruitingDrug Interaction Study Between Rifabutin And Lersivirine (UK-453,061)
Condition: Healthy Volunteers
Not yet recruitingThe Effect Of Lersivirine (UK-453,061) On Qt Intervals In Healthy Subjects
Condition: Healthy Volunteers
RecruitingPilot Study of Liposomal Doxorubicin Combined With Bevacizumab Followed by Bevacizumab Monotherapy in Adults With Advanced Kaposi's Sarcoma
Condition: Sarcoma, Kaposi
RecruitingEquivalence of Boosted Atazanavir Based Regimens and Currently Effective HAART Regimens
Condition: Pediatric HIV
Not yet recruitingMorphological and Functional Evaluation of Buttock Lipoatrophy Treatment With Macrolane
Condition: Buttock Lipoatrophy; HIV Infections
Not yet recruitingA Trial of 2 Options for Second Line Combination Antiretroviral Therapy Following Virological Failure of a Standard Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)+2N(t)RTI First Line Regimen
Condition: HIV Infections
Not yet recruitingIndividuals Currently Taking Boosted Atazanavir as Part of an HIV Treatment Regimen Will be Evaluated to See if Substituting Raltegravir for Nucleoside Transcriptase Inhibitors Will be Safe and Well Tolerated.
Condition: HIV
RecruitingProspective Evaluation Among Patients Infected by HIV 1 in Virological Failure Owing to Lack of Compliance, of the Benefit in Terms of Compliance of an Optimised Antiretroviral Treatment With Enfuvirtide (Fuzeon) Associated With Two Active Molecules
Condition: HIV1 Infection
Not yet recruitingComparing Daily Versus Intermittent Regimen of ATT (Ethambutol, Pyrazinamide, INH, Rifampicin) in HIV With Pulmonary Tuberculosis (TB)
Condition: HIV Associated Pulmonary TB
 
Important Notice:
This document has been submitted for publication to CDC's Morbidity and Mortality Weekly Report (MMWR) and should be considered a final draft. It is being posted on AIDSinfo to expedite dissemination of important clinical information. Upon acceptance and publication in MMWR, this draft will be removed and replaced by the published version. In the meantime, readers should be aware that the content of the draft might differ from the content of future published versions. Any corrections/questions concerning this document should be addressed to Ms. Jessica Carrington (e-mail: contactus@aidsinfo.nih.gov).
 
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