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MVC. Tropism testing should be performed before initiation of therapy; only patients found to have only CCR5-tropic virus are candidates for MVC. Regimens that may be acceptable but should be used with caution (Regimens that have demonstrated virologic efficacy in some studies but have safety, resistance, or efficacy concerns. See comments below.)

ABC together with caution because both can cause HSRs within first few weeks after initiation of therapy. Early virologic failure with high rates of resistance has been reported in some patients receiving

SQV/r SQV/r was associated with PR and QT prolongation in a healthy volunteer study Baseline ECG is recommended before initiation of SQV/r SQV/r is not recommended in patients with any of the following: Pretreatment QT interval >450 msec Refractory hypokalemia or hypomagnesemia Concomitant therapy with other drugs that prolong QT interval Complete AV block without implanted pacemaker Risk of complete AV block 3TC: lamivudine; ABC: abacavir; ATV: atazanavir; ATV/r: atazanavir/ritonavir; AV: atrioventricular; ddI: didanosine; DRV: darunavir; DRV/r: darunavir/ritonavir; ECG: electrocardiogram; EFV: efavirenz; FPV: fosamprenavir; FPV/r: fosamprenavir/ritonavir; FTC: emtricitabine; HSR: hypersensitivity reaction; INSTI: integrase strand transfer inhibitor; msec: millisecond; MVC: maraviroc; NNRTI: non-nucleoside reverse transcriptase inhibitor; NVP: nevirapine; PI: protease inhibitor; RAL: raltegravir; RTV: ritonavir; SQV: saquinavir; SQV/r: saquinavir/ritonavir; TDF: tenofovir; ZDV: zidovudine. * 3TC may be substituted with FTC or vice versa. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents, January 10, 2011. The United States Department of Health and Human Services.