Table 1. Recommended ARV Agents for the Treatment of Established HIV Infection< ____________________________________________________________________________ Preferred (AI): Strong evidence of clinical benefit and sustained suppression of plasma VL 1 highly active PI* + 2 NRTIs (one drug from column A and two from column B. Drugs are listed in random, not priority, order): Column A Column B Indinavir Nelfinavir Ritonavir Saquinavir (soft gel capsule) ZDV + ddI d4T + ddI ZDV + ddC ZDV + 3TC# d4T + 3TC# Alternative (BII): Less likely to provide sustained virus suppression; clinical benefits not determined 1 NNRTI (Nevirapine)** + 2 NRTIs (Column B, above) Saquinavir + 2 NRTIs (Column B, above) Not generally recommended (CI): Clinical benefit demonstrated, but initial virus suppression not sustained in most patients 2 NRTIs (Column B, above)† Not recommended (DI): Evidence against use, virologically undesirable All monotherapies d4T + ZDV ddC + ddI ddC + d4T ddC + 3TC _____________________________________________________________________________ < Source: NIH Panel Report to Define Principles of Therapy of HIV Infection. * The current hard gel capsule formulation of saquinavir is not recommended due to poor bioavailability. New formulations developed to increase the bioavailability of saquinavir are currently under study. ** The only combination of 2 NRTIs + 1 NNRTI that has been shown to reduce viremia to undetectable levels in the majority of patients is ZDV + ddI + Nevirapine. This combination was studied in ARV-naïve individuals. # High level resistance to 3TC develops within 2-4 weeks in partially suppressive regimens; optimal use is in 3-drug ARV combinations that reduce viral load to <500 copies/mL. ## ZDV monotherapy may be considered for prophylactic use in pregnant women with low VL and high CD4+ T cell counts, to prevent perinatal transmission. † Please see point 2.2 in Conclusions. Table 2. Suggested New Regimens for Patients Who Have Failed ARV Therapy*# ___________________________________________________________________________ Prior Regimen New Regimen (not listed in priority order) 2 NRTIs + Nelfinavir Ritonavir Indinavir Saquinavir 2 NRTIs + Nevirapine 2 NRTIs 1 NRTI 2 new NRTIs + Rit; or Ind; or Saq + Rit; or Nev + Rit; or Nev + Ind** Saq + Rit** or Nef + Nev Saq + Rit or Nef + Nev Saq + Rit or Nef + Ne 2 new NRTIs + a PI 2 new NRTIs + a PI 2 new NRTIs + aPI 2 new NRTIs + Nevirapine ___________________________________________________________________________ < Source: NIH Panel Report to Define Principles of Therapy of HIV Infection. * These suggested alternative regimens have not been proven to be clinically effective. ** There are some clinical trials with surrogate-marker data to support this recommendation. # Rit = ritonavir; Ind = indinavir; Saq = saquinavir; Nev = nevirapine; Nel = nelfinavir