Table 2.

Disease-Specific Considerations and Evidence Ratings for Use of Specific Antiretroviral Agents in HIV-Positive Patients With Selected Comorbidities

Disease	Disease-Specific Considerations	Ratinga
Renal insufficiency	Consider avoiding tenofovir because it may be associated with progression of chronic kidney disease	BIIIb,c
Osteoporosis, fragility fractures	Consider avoiding tenofovir because it may be associated with greater decrease in bone mineral density	BIIIb,c
Cardiovascular disease	Consider avoiding abacavir, ritonavir-boosted lopinavir, or ritonavir-boosted fosamprenavir	BIIIb,c
Depression, sleep disturbance	Consider discontinuation of efavirenz if sleep disturbance or depression persist while receiving this agent	AIIIc
End-stage liver disease	Avoid nevirapine; and use protease inhibitors with caution	CIIIb CIIIb,c
Hyperlipidemia	Use ritonavir-boosted protease inhibitors and efavirenz-based regimens with caution due to development or worsening of hyperlipidemia	AIIIb
HIV-hepatitis B virus coinfection	Nucleoside component of initial therapy should include tenofovir and either emtricitabine or lamivudine in HIV-HBV coinfection infection	AI-BIb,c,d
HIV-tuberculosis coinfection	Efavirenz is the preferred NNRTI component of an antiretroviral regimen in patients receiving concurrent rifampin-based tuberculosis therapy	AIb,c,d
Cognitive dysfunction	Early initiation of antiretroviral therapy may delay or treat HIV-associated neurocognitive disorder	BIIb

Abbreviations: HBV, hepatitis B virus, HIV, human immunodeficiency virus; NNRTI, nonnucleoside reverse transcriptase inhibitor; WHO, World Health Organization.

^aRatings are for strength of recommendations and quality of evidence and are based on the AHA system (http://guidelines.gov/ontexnt.aspx?id=15560) and are based on the consensus of DHHS (2013 Guidelines: http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf), IAS-USA (2012 guidelines: https://www.iasusa.org/content/antiretroviral-treatment-adult-hiv-infection-0), and WHO (2010 guidelines: http://www.who.int/hiv/pub/arv/adult2010/en/index.html).

^bRatings based on DHHS guidelines.

^cRatings based on IAS-USA guidelines.

^dRatings based on WHO guidelines.