HIV, Jimenez, Alternate Ending

Raltegravir Impopularity

2 tablets per day

no single tablet regimen

ae: increased CK

low genetic barrier

Elvitegravir

requires boosting

low genetic barrier

Dolutegravir Impopularity

INSTI, higher genetic barrier

twice a day

Bictegravir Popularity

INSTI, high genetic barrier

once a day

only availble in coformulation with emtricitabine/TAF (biktarvy)

Cabotegravir

long acting

low genetic barrier

Protease Inhibitors

• genetic barrier

• toleravility

• ddi

• ae

• highest genetic barrier

• highest tolerability issues

• ddi: cyp3a4 substrates

• ae: GI intolerance, metabolic complications (hyperlipidemia, insulin resistance, lipodystrophy)m- (redistribution of adipose tissue)

Atazanavir

• PK booster?

• ae

• ddi

• needs PK boost

• ae: hyperbilirubinemia, nephrolithiasis (rare)

• ddi: acid suppressants

Darunavir

• PK booster?

• ae

• genetic barrier?

• needs PK boost

• ae: rash (sulfonamide)

• highest genetic barrier

NNRTIs

• ae:

• NNRTIs with significant ddi:

• ae: hepatotoxicity, rash

• NNRTIs with significant ddi: nevirapine, efavirenz, etravirine

Efavirenz

• ae: CNS effects

• new lower dose option

mainly used NNRTIs

rilpivrine and doravirine

Rilpivirine

• ae:

• adme:

• ddi:

Rilpivirine

• ae: less CNS effects than efvirenz**

• adme: requires a full meal

• ddi: PPI, antacids, H2 blockers

Doravirine

• adme

• adme: no food requirement

Initial Regimens (alternative)

2 NRTIs + another drug

Same Day/Rapid Start Regimen

Biktarvy

dolutegravir + lamivudine or emtricitabine

symtuza