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Recommendations Reflect Changing Views About Antiretroviral Agents


Toxicities associated with stavudine (Zerit—Bristol-Myers Squibb) prompted an NIH panel to move the drug from preferred to alternative status in new recommendations released this fall. The revised guidelines incorporate emtricitabine (Emtriva—Gilead) into a first-line position in treatment schemes. They also recommend tenofovir disoproxil fumarate (tenofovir DF; Viread—Gilead) or zidovudine in combination with lamivudine (Epivir—GlaxoSmithKline) or emtricitabine as nucleoside reverse transcriptase inhibitor (NRTI) backbones for combining in triple therapy with either a non-NRTI (NNRTI) or protease inhibitor (PI). Finally, specific recommendations are provided for several situations and patient populations, including guidance on resistance testing, therapeutic drug monitoring, and guidelines for managing coinfections of HIV with hepatitis B, hepatitis C, and tuberculosis.


NIH Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.