Antiretroviral Regimens or Components That Should Not Be Offered At Any Time

Rationale Exception
Antiretroviral Regimens Not Recommended
MonotherapyRapid 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 combinationsRapid 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 regimenHigh rate of early virologic non-response seen when this triple NRTI combination was used as initial regimen in treatment naïve patientsNo exception
Tenofovir + didanosine + lamivudine. combination as a triple NRTI regimenHigh rate of early virologic non-response seen when this triple NRTI combination was used as initial regimen in treatment naïve patientsNo exception
Antiretroviral Components Not Recommended As Part of Antiretroviral Regimen
Saquinavir hard gel capsule as single protease inhibitorPoor oral bioavailability (4%)
Inferior antiretroviral activity when compared to other protease inhibitors
No exception
Stavudine + didanosineHigh 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 pregnancyTeratogenic 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 riskNo exception
Stavudine + zidovudine Antagonistic No exception
Stavudine + zalcitabine Additive peripheral neuropathyNo exception
Didanosine + ZalcitabineAdditive peripheral neuropathyNo exception
Atazanavir + indinavirPotential additive hyperbilirubinemiaNo exception
Emtricitabine + lamivudineSimilar 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

Adapted from DHHS guidelines, March 23, 2004

* When constructing an antiretroviral regimen for an HIV-infected pregnant woman, please consult. Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States in http://www.aidsinfo.nih.gov/guidelines