An antiretroviral regimen for a treatment-naive patient generally consists of two nucleoside reverse transcriptase inhibitors (NRTI), the backbone of the regimen ,  in combination with a third active antiretroviral drug from one of three drug classes: an integrase strand transfer inhibitor, a non-nucleoside reverse transcriptase inhibitor (NRTI) , or a protease inhibitor (PI) with a pharmacokinetic enhancer .

• Abacavir and lamivudine is the preferred backbone combination  for antiretroviral (ARV) -naive pregnant women [2].
• Atazanavir/ritonavir and darunavir/ritonavir are the preferred PI drugs for use in ARV-naive pregnant women [2]

TWO -NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR (NRTI) BACKBONES [2]

Abacavir (ABC) and lamivudine (3TC)  ; Epzicom
Combination of two nucleoside analogues.
Abacavir  is a Human Immunodeficiency Virus nucleoside reverse transcriptase inhibitor analog of guanosine M.W. 670.8 . Lamivudine  is a Hepatitis B Virus Nucleoside Analog Reverse Transcriptase Inhibitor and Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor. M.W. 229.3

• Indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents. Adult.
  One tablet orally once daily, in combination with other antiretroviral agents, with or without food.

Serious and sometimes fatal hypersensitivity reactions, with multiple organ involvement, have occurred with abacavir, a component of EPZICOM® (abacavir and lamivudine). Patients who carry the HLA-B*5701 allele are at a higher risk of a hypersensitivity reaction to abacavir. Prior to initiating therapy with abacavir, screening for the HLA-B*5701 allele is recommended; this approach has been found to decrease the risk of hypersensitivity reaction. Screening is also recommended prior to reinitiation of abacavir in patients of unknown HLA-B*5701 status who have previously tolerated abacavir. Because lamivudine requires dose adjustment in the presence of renal insufficiency, EPZICOM is not recommended for use in patients with creatinine clearance <50 mL/min . Contraindicated in patients with moderate to severe hepatic impairment and dose reduction is required in patients with mild hepatic impairment.

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues and other antiretrovirals

(Each  tablet contains  600 mg of  abacavir sulfate and 300 mg of lamivudine, 30 tablets per blister pack)
For full prescribing information see: Epzicom package insert State of Florida DOH Central Pharmacy 5/2010 at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e0fc8605-1d64-41ab-af7e-bcf66a57c1fd

Lamivudine (3TC) and zidovudine (ZDV); Combivir
Combination . Lamivudine  is a Hepatitis B Virus Nucleoside Analog Reverse Transcriptase Inhibitor and Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor. M.W. 229.3. Zidovudine is a Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor M.W. 267.2

• Indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents. Adult.
  One tablet orally twice daily.
  

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues and other antiretrovirals

( Each tablet contains 150 mg of lamivudine, 300 mg of zidovudine, 60 Tablets /Bottle )
For full prescribing information see Combivir package insert http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b03e286a-4d44-489a-89d0-ee563e1f280f

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Emtricitabine (FTC) and tenofovir disoproxil  fumarate (TDF); Truvada
Combination . Emtricitabine is a Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor. M.W. 247.3 Tenofovir Disoproxil Fumarate is a pro-drug, fumaric acid salt form of tenofovir. Tenofovir is a nucleotide analog HIV-1 reverse transcriptase inhibitor and an HBV reverse transcriptase inhibitor. M.W. 635.5

• Indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents. Adult.
  
  One tablet once daily taken orally with or without food.

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues and other antiretrovirals Adjust dose for patients with renal impairment

(Tablets contain 200 mg of emtricitabine  and 300 mg of tenofovir disoproxil )
For full prescribing information see Truvada package insert at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d0b3d18b-7e5d-49ea-bcaf-8408414e8094

PROTEASE INHIBITORS (PI) [2]

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Darunavir , (DRV) ,Prezista®
HIV Protease (aspartyl)  Inhibitor and Cytochrome P450 3A Inhibitor , M.W. 547.7

• Treatment of human immunodeficiency virus (HIV-1) infection in combination with a Two-NRTI Backbone. Adult

  Treatment-naďve adult patients and treatment-experienced adult patients with no darunavir resistance associated substitutions: 800 mg (one 800 mg tablet) taken with ritonavir 100 mg once daily and with food.
  
  Treatment-experienced patients . See full package insert.

(Oral suspension, 100 mg of darunavir per mL of suspension.75 , 150, 600, 800 mg tablets)
For full prescribing information see Prezista package insert at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=814301f9-c990-46a5-b481-2879a521a16f

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Atazanavir  (ATV),  Reyataz®
Azapeptide HIV-1  Protease Inhibitor. MW 704.9

• Treatment of human immunodeficiency virus (HIV-1) infection in combination with a Two-NRTI Backbone. Adult

Treatment-naive patients:

• REYATAZ 300 mg with ritonavir 100 mg once daily with food or REYATAZ 400 mg once daily with food.
• When coadministered with tenofovir, H2-receptor antagonist, or proton-pump inhibitor REYATAZ 300 mg with ritonavir 100 mg
•  When combined with efavirenz REYATAZ 400 mg with ritonavir 100 mg once daily

Treatment-experienced patients: See full package insert

Elevation in indirect (unconjugated) bilirubin attributable to atazanavir-related inhibition of hepatic uridine diphosphate glucuronosyltransferase (UGT) enzyme occurs frequently during treatment  [4,5] Patients with hepatitis B or C infection are at risk of increased transaminases or hepatic decompensation. Monitor hepatic laboratory tests prior to therapy and during treatment

 

(150,  300 mg capsules )
For full prescribing information see Reyataz package insert at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de96add2-7e96-4633-b205-19b3434010ce

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Ritonavir (RTV), Norvir®
HIV-1 and HIV-2  Protease Inhibitor, Cytochrome P450 3A Inhibitor, Cytochrome P450 2D6 Inhibitor, Cytochrome P450 2C19 Inducer, Cytochrome P450 3A Inducer, P-Glycoprotein Inhibitor, and Breast Cancer Resistance Protein Inhibitor . M.W. 720.9

Boosts the effect of other HIV proteases by blocking their degradation by cytochrome P450.

• Treatment of human immunodeficiency virus (HIV-1) infection in combination with a Two-NRTI Backbone. Adult

Starting dose of 300 mg twice daily and increased at 2 to 3 day intervals by 100 mg twice daily to maximum dose of 600 mg twice daily.

Co-administration of ritonavir with several classes of drugs including sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations ( Methergine® ) may result in potentially serious and/or life-threatening adverse events due to possible effects of ritonavir on the hepatic metabolism of certain drugs

(100 mg  tablets 80 mg/ml solution , 240 mL bottles))
For full prescribing information see Norvir package insert at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=624120b3-0a32-42a7-abfc-324e6b6c93df

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR  (NNRTI) [2]

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Efavirenz  (EFV) , SUSTIVA®
Human Immunodeficiency Virus 1Non-Nucleoside Reverse Transcriptase Inhibitor, Cytochrome P450 3A Inducer, Cytochrome P450 2B6 Inducer, Cytochrome P450 2C9 Inhibitor, Cytochrome P450 2C19 Inhibitor, and Cytochrome P450 3A4 Inhibitor. The chemical classification of efavirenz is Non-Nucleoside Analog.. M.W. 315.7
May be initiated after the first 8 weeks of pregnancy [2]

• Treatment of human immunodeficiency virus (HIV-1) infection. Adult.

600 mg orally, once daily, in combination with a protease inhibitor and/or nucleoside analogue reverse transcriptase inhibitors (NRTIs) .It is recommended that SUSTIVA be taken on an empty stomach, preferably at bedtime.

If SUSTIVA is coadministered with voriconazole, the voriconazole maintenance dose should be increased to 400 mg every 12 hours and the SUSTIVA dose should be decreased to 300 mg once daily using the capsule formulation (one 200-mg and two 50-mg capsules or six 50-mg capsules). SUSTIVA tablets should not be broken.

If SUSTIVA is coadministered with rifampin to patients weighing 50 kg or more, an increase in the dose of SUSTIVA to 800 mg once daily is recommended

For full prescribing information see Sustiva package insert at:
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=04b5c345-c446-43a4-83f0-509bc287e10b

 INTERGRASE INHIBITOR [2]

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Raltegravir (RAL) ; Isentress
Raltegravir is a Human Immunodeficiency Virus Integrase Strand Transfer Inhibitor .Blocks the integration of the viral genome into the host DNA. .M.W. 444.4


• Treatment of human immunodeficiency virus (HIV-1) infection in combination with a Two-NRTI Backbone

400 mg administered orally, twice daily with or without food.
During coadministration with rifampin, the recommended dosage of ISENTRESS is 800 mg twice daily with or without food.
 

(400 mg tablets. Bottles of 60)
For full prescribing information see Isentress package insert State of Florida DOH Central Pharmacy 8/2010 at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cbd3e1af-81f3-44f6-8e45-652deab7a508

INTRAPARTUM [2]

Zidovudine (ZDV); Retrovir IV
Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor M.W. 267.2

• Prevention of Maternal-Fetal HIV-1 Transmission [2]
  
  During labor and delivery administer zidovudine  2 mg per kg (total body weight) over 1 hour followed by a continuous intravenous infusion of 1 mg per kg per hour (total body weight) until clamping of the umbilical cord . IV zidovudine administration should begin 3 hours before the scheduled operative delivery.

Breastfeeding is not recommended in women with HIV infection in the United States

(Capsules 100-mg capsules; bottle of 100 .Syrup 10 mg zidovudine in each mL; bottle of 240 mL , Injection 10 mg zidovudine in each mL;.20‑mL single‑use vial )
For full prescribing information see Retrovir package insert ViiV Healthcare Company 2/2015 at: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6df09f15-b102-431c-adde-d7aeef6f5d84