!"#$% '##"%()*+,-,*%-. /,0"1 2!

'/3
4%5,0*50(6,0$7 80"91
age | 1
ur. lrame
:RTIs
Class effecLs:
All can cause lacLlc acldosls and hepaLlc sLeaLosls due Lo mlLochondrlal damage (d41 > ddl and Zuv > all
oLhers)
All musL be renally ad[usLed excepL abacavlr (A8C)
MosL cause headache, nausea, dlarrhea, vomlLlng, faLlgue
uo nC1 glve zldovudlne and sLavudlne LogeLher
uo nC1 glve dldanoslne and sLavudlne LogeLher (lncrease perlpheral neuropaLhy and pancreaLlLls)
lf glve dldanoslne and Lenofovlr LogeLher, MuS1 reduce dldanoslne dose

;*%*0,- <0$%) 4==0*6,$5,(% '#>(05$%5 ?(,%51 +(0 @*),-$5,(%
Abacavlr Zlagen A8C - MusL LesL paLlenL for PLA-8*3701 before lnlLlaLlon due
Lo hypersenslLlvlLy rxn LhaL can occurcan nC1 LvL8
rechallenge (glve warnlng card), usually occurs ln flrsL 6
weeks (fever, myalgla, n/v, u81l sxs, anorexla)
sympLoms worsen wlLh each dose
- uosage ad[usLmenL wlLh hepaLlc lnsufflclency
- osslble lncrease rlsk of Ml
uldanoslne vldex LC ddl - WelghL based doslng (< or > 60 kg)
- erlpheral neuropaLhy
- ancreaLlLls (lacLlc acldosls), avold alcohol
- lnsulln reslsLance
- 1ake x hr before or 2 hrs afLer meal (Cl lnLolerance)
LmLrlclLablne LmLrlva l1C - PyperplgmenLaLlon on hands/feeL
- Skln dlscoloraLlon
Lamlvudlne Lplvlr 31C - Mlnlmal LoxlclLy: h/a, dry mouLh

SLavudlne ZerlL d41 - WelghL based doslng (< or > 60 kg)
- erlpheral neuropaLhy
- ancreaLlLls (lacLlc acldosls)
- LlpoaLrophy
- lnsulln reslsLance
- 8apldly progresslng neuromuscular weakness
1enofovlr vlread 1ul - nephroLoxlc (waLch SCr)
- CsLeomalacla, decrease ln bone mlneral denslLy
- Cas, n/u/abdomlnal dlscomforL
Zldovudlne 8eLrovlr AZ1, Zuv - 8one marrow suppresslon: anemla, neuLropenla
- Comes ln lv form (durlng labor)
- nall plgmenLaLlon
- LacLlc acldosls/hepaLomegaly (rare)
- lnsulln reslsLance
- LlpoaLrophy
Combos
1ruvada l1C + 1ul See above
Lpzlcom 31C + A8C
Comblvlr 31C + AZ1
1rlzlvlr 31C +AZ1 +
A8C

!"#$% '##"%()*+,-,*%-. /,0"1 2!'/3
4%5,0*50(6,0$7 80"91
age | 2
ur. lrame

NNRTIs
Class effecLs:
Long half-llves
CreaLer rlsk of LreaLmenL fallure aL Llme of Lx Lhan wlLh ls
1ransmlLLed reslsLance more common Lhan ls
oLenLlal for cross reslsLance
8ash, lncludlng S!S and 1Ln
SlgnlflcanL C?430 drug lnLeracLlonsdependlng on nn81l, can be lnducer/lnhlblLor of speclflc C? enzymes
;*%*0,- <0$%) '#>(05$%5 ?(,%51 +(0 @*),-$5,(%
uelavlrdlne 8escrlpLor - noL used much anymore, less poLenL

Lfavlrenz SusLlva
(Llv)
- vlrologlc responses superlor Lo mosL comparlsons Lo daLe
- Cnce dally doslng, aL or rlghL before bedLlme
- 1ake on empLy sLomach Lo decrease ALs (lncrease ln faL
worsens ALs)
- Will cause hangover effect for flrsL 48 hours (drowsy,
dlzzy), normally wears off
- neuropyschlaLrlc sympLoms (lnsomnla, confuslon, abnormal
Lhlnklng, amnesla, halluclnaLlons, hlghly vlvld dreams,
euphorla)usually subsldes sponLaneously afLer 2-4 wks
- 1eraLogenlc (neural Lube defecL ln flrsL LrlmesLer)
- uysllpldemla
LLravlrlne lnLelence
(L18)
- 1ake followlng a meal
- PypersenslLlvlLy reacLlon (rash and someLlmes organ
dysfuncLlon-hepaLlc fallure been reporLed)
- nausea
nevlraplne vlramune or
vlramune x8
(nv)
- Plgher raLe of rash, Lead-ln perlod: 200 mg once dally x
14d, Lhen 200 mg 8lu or 400 Cu (x8), MusL repeaL lf d/c for
> 7days, ln paLlenLs LhaL develop mlld Lo moderaLe rash,
conLlnue lead-ln perlod unLll resolves (no > 28 days LoLal)
- PepaLoLoxlclLy (faLal hepaLlc necrosls), occurs ln hlgher freq
ln A8v-naive females wlLh Cu4+>230 and males >400,
Lherefore should noL lnlLlaLe ln Lhese paLlenLs
8llplvlrlne LduranL
(8v)
- Cnce dally doslng, musL Lake wlLh meal
- uepresslon
- lnsomnla, h/aless Lhan Llv
- PepaLoLoxlclLy
- 8equlres lower gasLrlc pP, Cl wlLh ls
- noL recommended ln pLs wlLh pre-Lx vlral load >100,000
- Plgher raLe of fallure ln pLs wlLh pre-Lx Cu4+<200 who are
LreaLed wlLh lL and 2 n81ls
Combos
ALrlpla Llv wlLh 1ul + l1C
Complera 8v wlLh 1ul +l1C



!"#$% '##"%()*+,-,*%-. /,0"1 2!'/3
4%5,0*50(6,0$7 80"91
age | 3
ur. lrame

PIs
Class effecLs:
MeLabollc compllcaLlons such as hyperllpldemla, llpodysLrophy, hyperglycemla/lnsulln reslsLance
Cl adverse effecLsn/v/u! 1ake almosL all wlLh food!
osslblllLy of lncreased bleedlng rlsk for hemophlllacs
Plghly proLeln bound
PepaLlcally meLabollzed- PepaLoLoxlc!
urug-drug lnLeracLlons- C?3A4 lnhlblLors!! (and subsLraLes) LC1S of lnLeracLlons
Plgher barrler Lo reslsLance (l reslsLance uncommon wlLh 81v boosLed PIs)

;*%*0,- <0$%) 4==0*6,$5,(% '#>(05$%5 ?(,%51 +(0 @*),-$5,(%
8lLonavlr norvlr 81v - Typically used as a booster for other PIs (except NFV) to
lncrease Lhelr blood concenLraLlons and have greaLer
anLlvlral effecLdont really see much by itself any more
due Lo Cl lnLolerance
- PepaLoLoxlclLy
- 1asLe perverslon
- 8efrlgeraLlon requlred for capsules by pharmacy (once
glven Lo pL can keep ouL of frldge for 30 days)
- 100 mg LableL does noL need refrlgeraLlon
Amprenavlr Agenerase Av - no longer used much

ALazanavlr
(boLh boosLed and
unboosLed wlLh 81v)
8eyaLaz A1v - Cnce-dally, Lake wlLh food
- MusL boosL wlLh Llv and 1ul
- uo noL co-admlnlsLer wlLh nv
- Pyperblllrublnemla (does noL requlre d/c) and [aundlce
- 8 prolongaLlon
- nephrollLhlasls, cholellLhlaslsloLs of waLer! (hlsLory of
kldney sLones lncrease rlsk), medlan Llme Lo onseL ls 42
monLhs
- uose ad[usLmenL wlLh hepaLlc lnsufflclency
- 8 prolongaLlon
- AbsorpLlon depends on food and low gasLrlc pPcan
only use l ln naive paLlenLs, no > Lhan 20 mg
omeprazole Lhough
uarunavlr rezlsLa

u8v - Cnce-dally wlLh food
- oLenL vlrologlc efflcacy
- 8ash- S!S, 1Ln
- WaLch wlLh sulfa allergy
- Llver LoxlclLy
losamprenavlr Lexlva lv - 1wlce dally doslng (shown lncreased efflcacy), wlLh food
- Cl lnLolerance
- 8ash
- Pyperllpldemla
- WaLch wlLh sulfa allergy
- uose ad[usLmenL wlLh hepaLlc lnsufflclency
- osslble lncreased rlsk of Ml
!"#$% '##"%()*+,-,*%-. /,0"1 2!'/3
4%5,0*50(6,0$7 80"91
age | 4
ur. lrame
lndlnavlr Crlxlvan luv - 1wlce-dally, on empLy sLomach
- nephrollLhlaslsaL leasL 1.3 L waLer/day!
- Pyperblllrublnemla
- Cl lnLolerance
- uose ad[usLmenL wlLh hepaLlc lnsufflclency
- ulabeLes/lnsulln reslsLance
Loplnavlr kaleLra Lv - Co-formulaLed
- Cnce dally has lower Lrough concenLraLlons
- Lower drug exposure durlng pregnancyuse Lwlce dally
doslng, may need dose lncrease ln 3
rd
LrlmesLer
- Cl lnLolerance- u/n/v
- ulabeLes/lnsulln reslsLance/hyperllpldemla
- osslble lncreased rlsk of Ml w/ cumulaLlve use
- 8 and C1 prolongaLlon
nelflnavlr vlracepL nlv - noL boosLed wlLh 81v
- ularrheacan use loperamlde or
dlphenoxylaLe/aLroplne
Saqulnavlr lnvlrase SCv - no longer used much
- PlghesL plll burden (6/day) wlLh food
- Cl lnLolerance
- 8 and C1 prolongaLlon (need ECG prior to tx); dont use
wlLh oLher C1 prolonglng drugs
1lpranavlr ApLlvus 1v - Cl lnLolerance: 1ake wlLh food.
- 8ash
- Pyperllpldemla
- WaLch wlLh sulfa allergy
- Llver LoxlclLy
- 8lack box warnlng for:
- ModeraLe-Lo-severe hepaLlc lnsufflclency (lncreases
Ll1s)
- lnLracranlal hemorrhage
Combos
kaleLra Lv and 81v See above














!"#$% '##"%()*+,-,*%-. /,0"1 2!'/3
4%5,0*50(6,0$7 80"91
age | 3
ur. lrame



'%5*90$1* '%A,=,5(01

;*%*0,- <0$%) '#>(05$%5 ?(,%51 +(0 @*),-$5,(%
LlvlLegravlr (LvC)
- Co-formulaLed wlLh
coblclsLaL (CC8l)/1ul/l1C
- CoblclsLaL ls an
pharmacoklneLlc enhancer
SLrlblld - Cnce-dally doslng, wlLh food
- nausea and dlarrhea
- non-lnferlor Lo ALrlpla and A1v/r +1ul/l1C
- CC8l-poLenL C?3A4 lnhlblLorDDIs
- CC8l lnhlblLs secreLlon of creaLlnlne, decrease CrClcan
cause/worsen renal funcLlon, only ln pLs wlLh basellne
CrCl> 70 mL/mln and d/c Lherapy lf CrCl <30 mL/mln or lf
SCr lncreases 0.4 mg/dL or more, may lncrease 1ul
LoxlclLy
- Lower barrler Lo reslsLance Lhan boosLed l
8alLegravlr (8AL) lsenLress


- 1wlce-dally doslng
- lncreased Ck (muscle weakness/ rhabdomyolysls)
- LlpohyperLrophy
- 8ash (rare S!S and 1LnS)
- nausea and dlarrhea
- lewer uul Lhan l-, nn81l-, MvC-based reglmens




B%50. '%A,=,5(01
;*%*0,- <0$%) '#>(05$%5 ?(,%51 +(0 @*),-$5,(%
LnfuvlrLlde luzeon (1-20)

- 90 mg sub-C 8lu ln upper arm/leg, sLomach, roLaLe slLes
each LlmeexLenslve counsellng on Lhls
- 8efrlgeraLe afLer reconsLlLuLlon, Lhen only sLable for 24
hours
- ln[ecLlon slLe rxns (eryLhema, cysLs, nodules), headache,
fever, neuLropenla
CCDE 4%5$9(%,151
Maravlroc (MvC) SelzenLry - 1wlce-dally doslng
- MusL do vlral Lroplsm (addlLlonal cosL/delay ln Lx)
- lewer ALs Lhan Llv
- u/n, u81l, cough, [olnL/muscle paln
- PepaLoLoxlclLy
- DDIs
- Less long-Lerm experlence Lhan l-, nn81l- reglmens
- LlmlLed experlence wlLh dual-n81ls oLher Lhan Zuv/31C
- C?3A4 subsLraLe