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: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 10/12/18 (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)
  • Switch From a Higher to a Lower Dose of Ritonavir
    • HIV-infected patients experiencing adverse events associated with the use of ritonavir have switch options that include a lower dose of ritonavir (Table 4) 
    Switch From a Ritonavir-Boosted PI to Unboosted AtazanavirSwitch From a Ritonavir-Boosted PI to Efavirenz
      Switch From a Ritonavir-Boosted PI to Rilpivirine
        Switch From a Boosted PI to Raltegravir
          Switch From a Boosted PI to Elvitegravir
            Switch From a Boosted PI to Bictegravir/Emtricitabine/Tenofovir AF
              Switch From Multiple Classes to Abacavir/Dolutegravir/Lamivudine
                Switch From a Dolutegravir-Based Regimen to Bictegravir/Emtricitabine/Tenofovir AF
                  Switching From Multiple Classes to a Ritonavir-Sparing and NRTI-Sparing Regimen

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