Contraindicated antiretroviral drug regimens

Antiretroviral drug regimens that should not be oﬀered at any time are shown in Table 8.

Table 8. Antiretroviral drug regimens that should not be offered at any time (see the DHHS guidelines for exceptions^[2])

Antiretroviral drug regimen	Rationale
Monotherapy with NRTIs	Inferior virological activity plus rapid development of resistance
Dual-NRTI regimens	Inferior virological activity plus rapid development of resistance.
Triple-NRTI regimens	High rate of early virological nonresponse. The only exceptions are abacavir/zidovudine/lamivudine and possibly tenofovir DF + zidovudine/lamivudine (Evidence: BII) in patients in whom other combinations are not desirable

Nevirapine in ART-naïve women and men with CD4+ T cell counts ≥ 250 cells/μL and 400 cells/μL, respectively	Greater risk of severe, life-threatening hepatotoxicity
Unboosted saquinavir, darunavir or tipranavir	Inadequate bioavailability
Nevirapine + efavirenz, or nevirapine/ efavirenz/ etravirine	Higher incidence of toxicity and similar resistance profiles
Emtricitabine + lamivudine	Similar resistance profiles, no potential benefit
Etravirine + unboosted PI	ETR may induce metabolism of PIs; appropriate doses not yet established
Etravirine + ritonavir-boosted atazanavir or fosamprenavir	ETR may alter the concentrations of these PIs; appropriate doses not yet established
Etravirine + ritonavir-boosted tipranavir	ETR concentration may be significantly reduced by ritonavir -boosted TPV