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: 3/17/20 (What's New)

Supporting Assets

Table 1 | Table 2 | Table 3

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 DF or AF, 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 DF or AF, 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 DF or AF	↓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 DF, cobicistat/elvitegravir/emtricitabine/tenofovir DF or AF, doravirine/lamivudine/tenofovir DF		ARIES^{[Squires 2010; Squires 2012]}INDUMA^{[Ghosn 2011]}SPIRIT^{[Palella 2014]} SWAN^{[Gatell 2007]}STRATEGY-PI^{[Arribas 2014]}DRIVE-SHIFT^{[Johnson 2019]}
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 DF, emtricitabine/rilpivirine/tenofovir DF or AF, doravirine/lamivudine/tenofovir DF, or INSTI-based regimen	↓TG ↑ Convenience	AI266-073^{[DeJesus 2009]} SPIRIT^{[Palella 2014]} DRIVE-SHIFT^{[Johnson 2019]}

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

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Keywords: Switch Strategies