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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
- Home
- Guidelines
- Adult and Adolescent ARV
- Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
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?
- Panel Roster
- Financial Disclosure
- Introduction
- Baseline Evaluation
- Laboratory Testing
- Treatment Goals
- Initiation of Antiretroviral Therapy
- Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)
- What to Start
- What Not to Use
- 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
- Conclusion
- Appendix A: Key to Acronyms
- Appendix B: Drug Characteristics Tables
Download Guidelines
- Section Only PDF (236 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 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Last Updated: December 18, 2019; Last Reviewed: December 18, 2019
Appendix B, Table 3. Characteristics of Nucleoside Reverse Transcriptase Inhibitors
The older NRTIs ddI and d4T are no longer commonly used in clinical practice and have been removed from this table. Please refer to the July 10, 2019, version of the guidelines (found in the archived guidelines section of AIDSinfo) or to the FDA product labels for ddI and d4T for information regarding these drugs.
|
Generic Name (Abbreviation) Trade Name |
Formulations | Dosing Recommendationsa | Elimination/ Metabolic Pathway | Serum/ Intracellular Half-Lives | Adverse Eventsb |
|---|---|---|---|---|---|
| Abacavir (ABC) Ziagen Note: Generic tablet formulation is available. |
Ziagen:
|
Ziagen:
|
Metabolized by alcohol dehydrogenase and glucuronyl transferase
82% of ABC dose is excreted renally as metabolites Dose adjustment is recommended in patients with hepatic insufficiency (see Appendix B, Table 10). |
1.5 hours/12–26 hours | Patients who test positive for HLA-B*5701 are at the highest risk of experiencing HSRs. HLA screening should be done before initiating ABC.
For patients with a history of HSRs, re-challenge is not recommended. Symptoms of HSRs may include fever, rash, nausea, vomiting, diarrhea, abdominal pain, malaise, fatigue, or respiratory symptoms (e.g., sore throat, cough, or shortness of breath). Some cohort studies suggest an increased risk of MI with recent or current use of ABC, but this risk is not substantiated in other studies. |
| Emtricitabine (FTC) Emtriva |
Emtriva:
|
Emtriva Capsule:
|
86% of FTC dose is excreted renally See Appendix B, Table 10 for dosing recommendations in patients with renal insufficiency. |
10 hours/>20 hours | Minimal toxicity Hyperpigmentation/skin discoloration Severe acute exacerbation of hepatitis may occur in patients with HBV/HIV coinfection who discontinue FTC. |
| Lamivudine (3TC) Epivir Note: Generic products are available. |
Epivir:
|
Epivir:
|
70% of 3TC dose is excreted renally
See Appendix B, Table 10 for dose recommendations in patients with renal insufficiency. |
5–7 hours/18–22 hours | Minimal toxicity
Severe acute exacerbation of hepatitis may occur in patients with HBV/HIV coinfection who discontinue 3TC. |
| Tenofovir Alafenamide (TAF) Vemlidy Note: Vemlidy is available as a 25-mg tablet for the treatment of HBV. |
FDC Tablets that Contain TAF:c
|
See Appendix B, Tables 1 and 2 for dosing information for FDC tablets that contain TAF. | Metabolized by cathepsin A See Appendix B, Table 10 for dosing recommendations in patients with renal insufficiency. |
0.5 hours/150–180 hours | Renal insufficiency, Fanconi syndrome, and proximal renal tubulopathy are less likely to occur with TAF than with TDF.
Osteomalacia and decreases in BMD are less likely to occur with TAF than with TDF. Severe acute exacerbation of hepatitis may occur in patients with HBV/HIV coinfection who discontinue TAF. Diarrhea, nausea, headache |
| Tenofovir Disoproxil Fumarate (TDF) Viread Note: Generic product is available. |
Viread:
|
Viread:
See Appendix B, Tables 1 and 2 for dosing information for FDC tablets that contain TDF. |
Renal excretion is the primary route of elimination.
See Appendix B, Table 10 for dose recommendations in patients with renal insufficiency. |
17 hours/>60 hours | Renal insufficiency, Fanconi syndrome, proximal renal tubulopathy
Osteomalacia, decrease in BMD Severe acute exacerbation of hepatitis may occur in patients with HBV/HIV coinfection who discontinue TDF. Asthenia, headache, diarrhea, nausea, vomiting, flatulence |
| Zidovudine (ZDV) Retrovir Note: Generic products are available. |
Retrovir:
|
Retrovir:
|
Metabolized to GAZT
Renal excretion of GAZT See Appendix B, Table 10 for dosing recommendations in patients with renal insufficiency. |
1.1 hours/7 hours | Macrocytic anemia Neutropenia Nausea, vomiting, headache, insomnia, asthenia Nail pigmentation Lactic acidosis/severe hepatomegaly with hepatic steatosis (this is a rare, but potentially life-threatening, toxicity) Hyperlipidemia Insulin resistance/diabetes mellitus Lipoatrophy Myopathy |
| 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 2 for information about these formulations. d See Appendix B, Table 1 for information about these formulations. Key: 3TC = lamivudine; ABC = abacavir; BIC = bictegravir; BMD = bone mineral density; CrCl = creatinine clearance; d4T = stavudine; ddI = didanosine; DOR = doravirine; DRV/c = darunavir/cobicistat; DTG = dolutegravir; EC = enteric coated; EFV = efavirenz; EVG/c = elvitegravir/cobicistat; FDC = fixed-dose combination; FDA = Food and Drug Administration; FTC = emtricitabine; GAZT = azidothymidine glucuronide; HBV = hepatitis B virus; HLA = human leukocyte antigen; HSR = hypersensitivity reaction; IV = intravenous; MI = myocardial infarction; RPV = rilpivirine; STR = single-tablet regimen; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; WHO = World Health Organization; ZDV = zidovudine |
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Download Guidelines
- Section Only PDF (236 KB)
- Full Guideline PDF (4.7 MB)
- Recommendations Only PDF (88.9 KB)
- Tables Only PDF (563 KB)
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