AIDS SOCIETY OF INDIA

Antiretroviral Regimens Not Recommended

• Some antiretroviral regimens or components are not recommended for HIV-1 infected patients due to sub-optimal antiviral potency, unacceptable toxicity, or pharmacological concerns. These are summarized below:
• Monotherapy and dual nucleoside therapy: These regimens are not recommended because they have not demonstrated potent and sustained antiviral activity.45
• Tenofovir + ddI + NNRTI is not recommended as an initial regimen due to reports of early virological and immunological failure.46
• 3-NRTI regimen of abacavir + tenofovir + lamivudine and didanosine + tenofovir + lamivudine should be avoided due to high rates of virological failure.47 These combinations should not be used as a 3-NRTI regimen in any patient.
• 4. Didanosine + stavudine: The combined use of didanosine and
• stavudine as a 2-NRTI backbone can result in a high incidence of toxicities, particularly peripheral neuropathy,
• pancreatitis, and lactic acidosis. In general, a combination
• containing didanosine and stavudine should be avoided unless
• other 2-NRTI combinations have failed or have caused
• unacceptable toxicities, and where potential benefits outweigh the risks of toxicities.48
• Stavudine + zidovudine: Combination regimens containing these two NRTIs should be avoided due to the demonstration of antagonism in vitro and in vivo 6. Unboosted PIs should be avoided if possible due to poor
  • bioavailability and higher pill burden.
• Do not alter dosages or schedules of ARV Drugs
• Efavirenz should be avoided in pregnancy or in women who plan pregnancy.
• Nevirpaine should be avoided in women with CD4count>250/mm3 and in men with CD4 count>400/mm3.

Antiretroviral strategies, which are not recommended

• Induction-maintenance: Initiation of three Drug ART and then reducing it to a combination of two ARV Drugs is not recommended
• Sequential adding of Drugs: A third drug, especially NNRTI should not be added to an on-going two drug regimen, as it can lead to rapid selection of resistance.
• Structured treatment interruptions: Any form of treatment interruptions is not recommended in clinical practice unless a patient develops severe adverse events

UP AFTER INITIATING ART

Table 3 depicts the recommended follow up scheme after initiating ART.

• Frequent follow up during the initial months is necessary to diagnose and efficiently manage acute adverse events, work with the patient on adherence issues, and diagnose clinical conditions like IRIS. Once a patient is on an effective and stable regimen at 6 months, quarterly follow up is recommended.