 | Rationale | Exception |
|---|
| Antiretroviral Regimens Not Recommended |
| Monotherapy | Rapid development of resistance
Inferior antiretroviral activity when compared to combination with three or more antiretrovirals | Pregnant women with HIV-RNA < 1,000 copies/mL using zidovudine monotherapy for prevention ofperinatal HIV transmission* and notfor HIV treatment for the mother |
| Two-agents drug combinations | Rapid development of resistance
Inferior antiretroviral activity when compared to combination with three or more antiretrovirals | For patients currently on this treatment, it is reasonable to continue if virologic goals are achieved |
| Abacavir + tenofovir + lamivudine combination as a triple NRTI regimen | High rate of early virologic non-response seen when this triple NRTI combination was used as initial regimen in treatment naïve patients | No exception |
| Tenofovir + didanosine + lamivudine. combination as a triple NRTI regimen | High rate of early virologic non-response seen when this triple NRTI combination was used as initial regimen in treatment naïve patients | No exception |
| Antiretroviral Components Not Recommended As Part of Antiretroviral Regimen |
| Saquinavir hard gel capsule as single protease inhibitor | Poor oral bioavailability (4%)
Inferior antiretroviral activity when compared to other protease inhibitors | No exception |
| Stavudine + didanosine | High incidence of toxicities. peripheral neuropathy, pancreatitis, and hyperlactatemia
Reports of serious, even fatal, cases of lactic acidosis with hepatic steatosis with or without pancreatitis in pregnant women. | When no other antiretroviral options are available and potential benefits outweigh the risks* |
| Efavirenz in pregnancy | Teratogenic in nonhuman primate. | When no other antiretroviral options are available and potential benefits outweigh the risks * |
Amprenavir oral solution in:
pregnant women;
children < 4 yr old;
patients with renal or hepatic failure;
and patients treated with metronidazole or disulfiram | Oral liquid contains large amount of the excipient propylene glycol, which may be toxic in the patients at risk | No exception |
| Stavudine + zidovudine | Antagonistic | No exception |
| Stavudine + zalcitabine | Additive peripheral neuropathy | No exception |
| Didanosine + Zalcitabine | Additive peripheral neuropathy | No exception |
| Atazanavir + indinavir | Potential additive hyperbilirubinemia | No exception |
| Emtricitabine + lamivudine | Similar resistance profile
No potential benefit | No exception |
| Hydroxyurea | # CD4 count
$ ddI-associated side effects . such as pancreatitis & peripheral neuropathy
Inconsistent evidence of improved viral suppression
Contraindicated in pregnancy (Pregnancy Category D) | No exception |
