Mensajes claves – Guía Clínica EACS – European AIDS Clinical Society

• Doravirina esquema recomendado en las nuevas guías EACS 2021 de tratamiento Antirretroviral del HIV.

Regímenes recomendados

RegimenMain requirementsAdditional Guidance (see footnotes)
Recommended regimens
2 NRTIs = INSTI
ABC/3TC = DTG
ABC/3TC/DTG
HLA-B*57:01 negative
HBsAg negative
I (ABC: HLA-B*57:01, cardiovascular risk)
II (Weight increase (DTG))
TAF/FTC/BICII (Weight increase (BIC, TAF))
TAF/FTC OR TDF/XTC + DTGII (Weight increase (DTG, TAF))
III (TDF: prodrug types. Renal and bone toxicity. TAF dosing)
TAF/FTC OR TDF/XTC = RAL qd or bidII (Weight increase (RAL, TAF))
III (TDF: prodrug types. Renal and bone toxicity. TAF dosing)
IV (RAL: dosing)
1 NRTI = INSTI
XTC + DTG or 3TC/DTG HBsAg negative
HIV-VL < 500,000 copies/mL
Not recommended after PrEP failure
II (Weight increase (DTG))
V (3TC/DTG not after PrEP failure)
2 NRTIs = INSTI
TAF/FTC OR TDF/XTC + DOR or
TDF/3TC/DOR
II (Weight increase (TAF))
III (TDF: prodrug types. Renal and bone toxicity. TAF dosing)
IV (DOR: caveats, HIV-2)
Alternative regimens
2 NRTIs = INSTI
ABC/3TC + RAL 400 mg bidHBsAg negative
HLA-B*57:01 negative
I (ABC: HLA-B*57:01, may delay starting ART)
V (RAL in pregnancy, bid dosing)
2 NRTIs = NNRTI
ABC/3TC + EFVHLA-B*57:01 negative
HBsAg negative
HIV-VL < 100,000 copies/mL
At bedtime or 2 hours before dinner
I (ABC: HLA-B*57:01, may delay starting ART)
VIII
(EFV HIV-2 & group 0)
TDF/XTC of TAF/FTC = EFV or
TDF/FTC/EFV
At bedtime or 2 hours before dinner
TAF/FTC not recommended in first 14 weeks of pregnancy
III (Tenofovir salts)
IV (TAF & pregnancy)
VIII (EFV HIV-2 & group 0)
TDF/XTC of TAF/FTC = RPV or
TDF/FTC/RPV or
TAF/FTC/RPV
CD4 count > 200 cells/μL
HIV-VL < 100,000 copies/mL
Not on gastric pH increasing agents
With food
TAF/FTC not recommended in first 14 weeks of pregnancy
II (Tenofovir salts)
IV (TAF & pregnancy)
IX (RPV exposure during 2nd and 3rd trimester, HIV-2)
X (Interactions)
2 NRTIs = PI/r
ABC/3TC
+ DRV/r 600 mg/100 mg bid
HLA-B*57:01 negative
HBsAg negative
With food
I (ABC: HLA-B*57:01, may delay starting ART)
VI (DRV dosing)
VII (COBI boosting)

• El objetivo de la modificación del tratamiento debe ser eliminar o mejorar los eventos adversos, facilitar el tratamiento adecuado de las comorbilidades y mejorar la calidad de vida, el tratamiento con INSTI o TAF podría estar asociado a incremento de peso.

• Si el regimen antirretroviral no incluye un booster, TAF o TDF tienen un riesgo similar de eventos renales que llevan a la discontinuación a corto plazo y de fracturas ósea.

Lo invitamos a conocer las guías EACS.