What are the CDC guidelines on alternative regimens for the treatment of HIV infection in select patient populations?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; more...
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Answer

Answer

The below regimens are effective and tolerable, but have potential disadvantages when compared with the regimens recommended for most people with HIV (listed above), have limitations for use in certain patient populations, or have less supporting data from randomized clinical trials. However, these regimens may be preferred in some patients. Several two-drug treatment options are available for patients who cannot safely be prescribed a combination regimen that contains two NRTIs.

Recommended regimen options in certain clinical situations are listed below (*lamivudine may substituted for emtricitabine or vice versa, if a non-fixed dose NRTI combination is desired).

INSTI plus 2 NRTIs regimens are as follows:

  • Elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine
  • Elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine

NNRTI plus 2 NRTIs regimens are as follows:

  • Doravirine/tenofovir disoproxil fumarate/lamivudine or doravirine plus tenofovir alafenamide/emtricitabine
  • Efavirenz/tenofovir disoproxil fumarate/emtricitabine*
  • Efavirenz plus tenofovir alafenamide/emtricitabine
  • Rilpivirine/tenofovir disoproxil fumarate/emtricitabine* or rilpivirine/tenofovir alafenamide/emtricitabine (if HIV RNA < 100,000 copies/mL and CD4 >200 cells/µL)

Boosted PI plus 2 NRTIs regimens are as follows:

  • Darunavir/ritonavir plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine
  • Atazanavir/cobicistat or atazanavir/ritonavir plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine
  • Darunavir/cobicistat or darunavir/ritonavir plus abacavir/lamivudine* if HLA-B*5701 negative
  • Darunavir/cobicistat plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine

Regimens to consider when abacavir, tenofovir alafenamide, and tenofovir disoproxil fumarate cannot be used or are suboptimal are as follows:

  • Dolutegravir plus lamivudine (see information above on use of dolutegravir in nonpregnant women of childbearing potential and pregnant women early in pregnancy)
  • Darunavir/ritonavir plus twice-daily raltegravir if HIV RNA < 100,000 copies/mL and CD4 cell count >200 cells/µL
  • Darunavir/ritonavir once daily plus lamivudine

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