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Scientific/Clinical Member and Community Representative Nominations Are Being Accepted
The Department of Health and Human Services (HHS) Panel on Antiretroviral Guidelines for Adults and Adolescents is accepting nominations for new scientific/clinical members with expertise in HIV medicine, as well as nominations for a community representative. Nominations should be submitted to Alice Pau, Pharm.D., electronically (apau@niaid.nih.gov) by no later than January 10, 2020.
For more information on the scientific/clinical member nomination requirements, please read this news announcement.
For more information on the community representative nomination requirements, please read this news announcement.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV
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- Guidelines
- Adult and Adolescent ARV
- Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (Brief)
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
- Table of Contents
- What's New in the Guidelines?
- Introduction
- Laboratory Testing
- Initiation of Antiretroviral Therapy
- Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)
- What to Start
- Management of the Treatment-Experienced Patient
- Special Patient Populations
- Considerations for Antiretroviral Use in Patients with Coinfections
- Limitations to Treatment Safety and Efficacy
- Drug-Drug Interactions
- Appendix B: Drug Characteristics Tables
Download Guidelines
- Section Only PDF (219 KB)
- Full Guideline PDF (4.7 MB)
- Recommendations Only PDF (88.9 KB)
- Tables Only PDF (563 KB)
Appendix B: Drug Characteristics Tables
Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Last Updated: December 18, 2019; Last Reviewed: December 18, 2019
Appendix B, Table 4. Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors
The older NNRTI DLV is no longer commonly used in clinical practice and is not listed this table. Please refer to the FDA product label for DLV for information regarding this drug.
|
Generic Name (Abbreviations) Trade Name |
Formulations | Dosing Recommendationsa | Elimination/ Metabolic Pathway | Serum Half-Life |
Adverse Eventsb |
|---|---|---|---|---|---|
| Doravirine (DOR) Pifeltro |
Pifeltro:
|
Pifeltro:
|
CYP3A4/5 substrate | 15 hours | Nausea Dizziness Abnormal dreams |
| Efavirenz (EFV) Sustiva Note: Generic product is available. |
Sustiva:
|
Sustiva:
See Appendix B, Table 1 for dosing information for STRs that contain EFV. |
Metabolized by CYP2B6 (primary), 3A4, and 2A6 CYP3A4 mixed inducer/inhibitor (more an inducer than an inhibitor) CYP2B6 and 2C19 inducer |
40–55 hours | Rashd Neuropsychiatric symptomse Serum transaminase elevations Hyperlipidemia Use of EFV may lead to false-positive results with some cannabinoid and benzodiazepine screening assays QT interval prolongation |
| Etravirine (ETR) Intelence |
Intelence:
|
Intelence:
|
CYP3A4, 2C9, and 2C19 substrate CYP3A4 inducer CYP2C9 and 2C19 inhibitor |
41 hours | Rash, including Stevens-Johnson syndromed
HSRs, characterized by rash, constitutional findings, and sometimes organ dysfunction (including hepatic failure), have been reported. Nausea |
| Nevirapine (NVP) Viramune or Viramune XR Note: Generic products are available. |
Viramune:
|
Viramune:
Repeat lead-in period if therapy is discontinued for >7 days. In patients who develop mild-to-moderate rash without constitutional symptoms, continue lead-in dose until rash resolves, but do not extend lead-in period beyond 28 days total. |
CYP450 substrate
CYP3A4 and 2B6 inducer Contraindicated in patients with moderate to severe hepatic impairment. Dose adjustment is recommended in patients on hemodialysis (see Appendix B, Table 10). |
25–30 hours | Rash, including Stevens-Johnson syndromed
Symptomatic Hepatitis:
|
| Rilpivirine (RPV) Edurant |
Edurant:
|
Edurant:
See Appendix B, Table 1 for dosing information for STRs that contain RPV. |
CYP3A4 substrate | 50 hours | Rashd Depression, insomnia, headache Hepatotoxicity QT interval prolongation |
|
a For dose adjustments in patients with renal or hepatic insufficiency, see Appendix B, Table 10. When no food restriction is listed, the ARV drug can be taken with or without food. b Also see Table 17. c See Appendix B, Table 1 for information about these formulations. d Rare cases of Stevens-Johnson syndrome have been reported with the use of most NNRTIs; the highest incidence of rash was seen among patients who were receiving NVP. e Adverse events can include dizziness, somnolence, insomnia, abnormal dreams, depression, suicidality (e.g., suicide, suicide attempt or ideation), confusion, abnormal thinking, impaired concentration, amnesia, agitation, depersonalization, hallucinations, and euphoria. Approximately 50% of patients who are receiving EFV may experience any of these symptoms. Symptoms usually subside spontaneously after 2–4 weeks, but discontinuation of EFV may be necessary in a small percentage of patients. Late-onset neurotoxicities, including ataxia and encephalopathy, have been reported. Key: 3TC = lamivudine; ARV = antiretroviral; CD4 = CD4 T lymphocyte; CYP = cytochrome P; DLV = delavirdine; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; FDC = fixed-dose combination; FTC = emtricitabine; HSR = hypersensitivity reaction; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; RPV = rilpivirine; STR = single-tablet regimen; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; XR = extended release |
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Download Guidelines
- Section Only PDF (219 KB)
- Full Guideline PDF (4.7 MB)
- Recommendations Only PDF (88.9 KB)
- Tables Only PDF (563 KB)
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