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)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4

Table 1. Modifying Antiretroviral Therapy to Increase Tolerability and/or Decrease Toxicity

Toxicity

Offending Agent(s)

Switch Offending
Agent(s) to

Expected
Benefit

Clinical Trial(s)

CNS toxicity

Efavirenz

Etravirine, nevirapine, raltegravir, cobicistat/elvitegravir/emtricitabine/tenofovir, rilpivirine

CNS adverse event improvements

Schouten et al[Schouten 2010]
Waters et al[Waters 2011]
SWITCH-ER[Nguyen 2011]
STRATEGY-NNRTI[Pozniak 2014]
GS-111[Mills 2013]
Nelson et al[Nelson 2013]

Lipoatrophy

Thymidine analogues

Abacavir, tenofovir, darunavir/ritonavir monotherapy, or lopinavir/ritonavir monotherapy

Subclinical improvements/
prevention of further fat loss

RAVE[Moyle 2006]
SWEET[Fisher 2009]
934E[DeJesus 2008]
RECOMB[Ribera 2013]
ACTG A5110[Tebas 2009]
MONOI[Valantin 2012]
KRETA
[Bernardino 2013]

Dyslipidemia

Abacavir/lamivudine

Emtricitabine/tenofovir

↓TC, LDL

ROCKET II[Behrens 2012]
Moyle et al[Moyle 2015]
SWIFT[Campo 2013]

Diarrhea and/or dyslipidemia

Lopinavir/ritonavir 400/100 mg BID

Atazanavir/ritonavir 300/100 mg QD; raltegravir

↓TC, TG

↓Diarrhea*

ATAZIP[Mallolas 2009]
SWITCHMRK[Eron 2010]
SPIRAL[Martínez 2010]

Diarrhea and/or dyslipidemia

Ritonavir-boosted PI

Atazanavir; emtricitabine/rilpivirine/tenofovir, cobicistat/elvitegravir/emtricitabine/tenofovir

ARIES[Squires 2010; Squires 2012]
INDUMA[Ghosn 2011]
SPIRIT[Palella 2014]
SWAN[Gatell 2007]
STRATEGY-PI[Arribas 2014]
GS-111[Mills 2013]
Nelson et al[Nelson 2013]

Diarrhea and/or dyslipidemia

PI

NNRTI

NEFA[Martínez 2003]
Etra-Switch[Echeverría 2014]

Injection site reaction

Enfuvirtide

Raltegravir

↑ Tolerability

EASIER[De Castro 2009]

Dyslipidemia or frequent dosing

PI or NNRTI + 2 NRTIs

Coformulated efavirenz/emtricitabine/tenofovir

↓TG

↑ Convenience

AI266-073[DeJesus 2009]

BID, twice daily; CNS, central nervous system; QD, once daily; TC, total cholesterol; TG, triglycerides.
*Not proven in clinical trials.

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