Part B

1
Recommended First Line Regimens in Adults
Part B Module B1 Session 5
2
Objectives

• Identify the drugs to include in several
  first-line ARV regimens
• Discuss the use of these regimens in reference to
  in-country guidelines and availability

3
What therapy to begin with

• At least three antiretrovirals are needed to
  achieve the following desirable outcomes of
  antiretroviral therapy
• drastically reduce viral replication
• prevent the emergence of resistance and treatment
  failure for a significant amount of time
• Choices include
• six nucleoside reverse transcriptase inhibitor
  (NtRTIs)
• three non-nucleoside reverse transcriptase
  inhibitors (NNRTIs) and
• six protease inhibitors (PIs)

4
 Table X. Approved antiretroviral agents included
in WHOs ARV guidelinesa
Approved and generally available in
industrialized countries as of January 2002.
5
How to start therapy

• Use the simplest three-drug combination as the
  first line therapy. Simple
• As few pills a day as few times as possible
• Cheapest
• Of sufficient potency to have desired effect
• Few side effects
• If the first line drugs fail, select the next one
  or two combinations on the list as the second
  line therapy

6
Table X. Recommended first-line ARV regimens in
adults and adolescents with documented HIV
infection
ZDV and d4T should never be used together because
of proven antagonism. Fixed-dose formulations are
preferred whenever possible as they promote
enhanced drug adherence. b RTV-PI includes IDV/r,
LPV/r, or SQV/r. c Subsequent research does not
support this regimen and WHO is currently
revising its Guidelines.
 a ZDV/3TC is listed as initial recommendation
for dual NsRTI component based on efficacy,
toxicity, clinical experience and availability of
fixed-dose formulation. Other dual NsRTI
components can be substituted, including d4T/3TC.
d4T/ddI and ZDV/ddl, depending on
country-specific preference
d Research shows that first choice should not
include the 2 NRTIs and a ritonavir-enhanced PI
or nelfinavir. Such a regimen should only be used
if a NNRTI regimen is not indicated, e.g., in the
case of an HIV-2 infection or if a patient
presents with side effects to EFZ or NVP.
7
Thank You