HIV infection
Chronic viral infection affecting CD4 lymphocytes. Untreated, it progresses to AIDS with severe immunodeficiency. Antiretroviral therapy (ART) suppresses the virus and preserves immunity.
ICD-10 B204 drugs
Also known as: Human immunodeficiency virus infection
Drugs used for this condition
- AAtazanavirSecond line · Antiretroviral, HIV protease inhibitorAtazanavir is a second-line HIV-1 protease inhibitor. GeSIDA 2024 places it as an option when dolutegravir or bictegravir are not tolerated, usually combined with ritonavir or cobicistat as a booster plus 2 NRTIs. Advantage over other protease inhibitors – minimal lipid impact. Main limitation – gastric acid dependent absorption.
- ACobicistatFirst line · Pharmacokinetic enhancer (booster) for antiretroviral therapyCobicistat is a pharmacokinetic enhancer in first-line antiretroviral therapy for HIV. GeSIDA 2024 recommends cobicistat-based combinations (Symtuza, Genvoya, Evotaz) in patients who need darunavir- or elvitegravir-based regimens with preserved renal function (eGFR > 70 mL/min). Drug-interaction review is mandatory – cobicistat inhibits CYP3A4 and raises levels of most co-administered drugs.
- ADarunavirSecond line · Second-generation HIV protease inhibitorDarunavir is a second-line HIV-1 protease inhibitor. GeSIDA 2024 recommends darunavir-based combinations (Symtuza, Rezolsta, Prezcobix) in patients with resistance to earlier protease inhibitors or when an integrase-inhibitor-free regimen is required. Booster (ritonavir 100 mg or cobicistat 150 mg) is mandatory.
- BEfavirenzSecond line · Antiretroviral, non-nucleoside reverse transcriptase inhibitor (NNRTI)Efavirenz is a second-line NNRTI in HIV-1 antiretroviral therapy. GeSIDA 2024 places it as an option when first-line integrase inhibitors are unavailable. Usually taken in the evening before sleep to minimise neuropsychiatric adverse effects. In women of childbearing age – discuss contraception and risk of CNS defects in the first trimester.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit