Modifying Antiretroviral Therapy in Virologically Suppressed HIV-Infected Patients

  • Author: José R. Arribas, MD (More Info)
  • Section Editor: Eric S. Daar, MD
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 10/18/21 (What's New)


  • Most common reasons to modify a virologically suppressive boosted PI–containing regimen are gastrointestinal adverse effects (nausea and diarrhea), high cardiovascular risk, dyslipidemia, pharmacologic interactions with ritonavir, and regimen simplification (less-frequent dosing, lower pill burden)
  • Switching From a Ritonavir-Boosted PI to Rilpivirine
    • This switch indication for emtricitabine/rilpivirine/tenofovir DF was based on results from the SPIRIT trial, a randomized, open-label, noninferiority phase IIIb study in which virologically suppressed patients were switched from ritonavir-boosted PI–based regimens to the single-tablet regimen of emtricitabine/rilpivirine/tenofovir DF and evaluated over a 48-week period[Palella 2014]
    • Patients were randomized to switch immediately or delay the treatment switch for 24 weeks. The single-tablet regimen was noninferior to continued boosted PI–based therapy based on a Week 24 FDA Snapshot analysis, and 89.3% of patients in the immediate switch arm maintained virologic suppression (< 50 copies/mL) after 48 weeks of therapy
    Switching From a Boosted PI to Doravirine
      Switching From a Boosted PI to an INSTI-Based Regimen

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