The most commonly used first line combinations
| Drug name and comments | Side effects | Other notes |
|---|---|---|
| Efavirenz (Sustiva/Stocrin) Efavirenz is recommended as part of a first-line therapy. It is 1 pill, once-daily. Side effects, which can be significant, usually reduce after the first few weeks. |
Side effects are sleep disturbance (including nightmares), mood changes (including anxiety and depression), rash, liver toxicity and lipid changes. About 20% people switch to another drug. | Efavirenz should not be used during pregnancy or by women trying to conceive a baby. |
| Nevirapine (Viramune) Nevirapine is an alternative to efavirenz, but has a slightly higher risk of serious side effects. Nevirapine is started at 1 tablet a day for the first 2 weeks, and then 1 tablet twice-daily. |
Main side effects are rash and liver toxicity. These occur in the first 6-8 weeks. Any low level rash should be taken seriously. Serious rash can be fatal. If you still have a rash after the first two weeks do not increase the nevirapinr dose. Your doctor needs to see any rash. | Women with a CD4 count over 250 and men with a count over 400 should not start with nevirapine. |
| Lopinavir/r (Kaletra) Kaletra is less widely used as a first-line protease inhibitor because it is a twice-daily drug. Kaletra includes ritonavir inside the same pill. |
Main side effects are changes in lipids (blood fat) which should be routinely monitored, lipodystrophy (fat accumulation) and diarrhoea. The daily dose of ritonavir in Kaletra is 200 mg daily. | Kaletra includes lopinavir and ritonavir in the same pill. |
| Atazanavir/r (Reyataz) Atazanavir/r now widely used as first-line treatment, because it is dosed once-daily and generally easy to tolerate. Usually taken with a separate dose of 100 mg ritonavir. |
Main side effects are yellowing eyes or skin in 10% of patients. This is not a problem unles total bilirubin levels increase to 60-70 mmol/L. Lipids can increase due to the use of ritonavir. | Taken with a separate dose of ritonavir (/r), unless you have high drug levels. |
| Darunavir/r (Prezista) Approved as a once-daily first-line PI for naive patients. | When compared to Kaletra, darunavir had lower rates of nausea, diarrhoea and lipid changes. | Taken with a separate dose of ritonavir (/r). |
| Fosamprenavir/r (Telzir) In studies fosamprenavir/r had similar results to Kaletra, but is less commonly used. |
Side effects, including diarrhoea and lipids are similar to Kaletra. | Taken with a separate dose of ritonavir (/r). |
| Saquinavir/r (Invirase) Saquinavir/r has shown similar results to Kaletra. There is less comparative data to Kaletra than for fosamprenavir/r. |
Side effects, including diarrhoea and lipds are similar to Kaletra. May have a lesser effect on trigliceride levels. | Taken with a separate dose of ritonavir (/r). |
Each option is used with either Truvada (tenofovir + FTC) or Kivexa (abacavir + 3TC).