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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]
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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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