Adults

Recommended combination regimens without a PI

Two NsRTIs (e.g. zidovudine/lamivudine) + one NNRTI (either nevirapine or efavirenz) or three NsRTIs (including abacavir), e.g. zidovudine/lamivudine/abacavir

Alternative NsRTI combinations (not in preferred order):

zidovudine + didanosine stavudine + lamivudine or didanosine

Zidovudine and stavudine should not be used together because of their mutually antagonistic effect. Didanosine and zalcitabine may lead to additive neurotoxicity and should not be combined.

Recommended combination regimens containing a PI Two NsRTIs + one PI, e.g. zidovudine/lamivudine/indinavir

These are effective regimens. However, there are some disadvantages, such as complex dosing schedules, drug interactions with rifampicin,and concern over long-term toxicity of PIs.

Recommended first-line ARV combination regimens in adults and adolescents with documented HIV infection

Regimen*

Pregnancy Considerations

Major toxicities

ZDV/3TC/EFZ or ZDV/3TC/NVP

Substitute NVP for EFZ in pregnant women or women for whom effective contraception cannot be assured

ZDV-related anaemia EFZ-associated CNS symptoms

Possible teratogenicity of EFZ

NVP-associated hepatotoxicity and severe rash

ZDV/3TC/ABC

ABC safety data limited

ZDV-related anaemia ABC hypersensitivity

ZDV/3TC/ PI** or ZDV/3TC/NFV

LPV safety data limited NFV: most supportive safety data

ZDV-related anaemia NFV-associated diarrhoea IDV-related nephrolithiasis PI-related metabolic side-effects

*ZDV/3TC is listed as the 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/ddI depending upon country-specific preferences. ZDV/d4T should never be used together because of proven antagonism. ** PIs include IDV, LPV, and SQV.

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