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not recommended that physicians responsible for the care of HIV-infected patients include first-generation NNRTI ART drugs in the starting regimen without first conducting a resistance test in cases where there is a high risk of NNRTI resistance as a result of the use of this group of drugs in PMTCT [37,96,104,128,129] (2B).

Physicians responsible for the care of HIV-infected patients are discouraged from using certain ARVs and combinations of ARVs that have an increased risk of adverse effects [130] (5C).

Comments: Adverse effects include low efficacy of ART, formation of ARVP-resistant HIV strains, general toxicity, teratogenicity, hepatotoxicity, decreased ARVP levels, and others (Table 1). Antiretroviral drugs and their combinations not recommended for ART. [37] (4C) Not recommended for use Detail of adverse effects Regimen consisting of 1 or 2 ARVs, except for regimens approved for simplified regimens Low efficacy and high likelihood of developing resistance Combination of analogues of one nucleoside (ZDV**+d4T**, FTC+3TC**) Reduced efficiency d4T** + ddI** Increased toxicity and risk of life-threatening complications, especially during pregnancy TDF** + ddI** Increased toxicity of ddI, decreased immunological efficacy of therapy EFV** + NVP** or ETR** Increased toxicity NVP** at CD4 count:-1 - women >250 µl-1 - men >400 µl Increased likelihood of developing hepatotoxicity as a manifestation of a hypersensitivity reaction It is not recommended to start ART during pregnancy ETR** + PIs not boosted by RTV** Decrease in PI concentration ETR** + ATV**/r** or FPV**/r** Decrease in PI concentration ETR**+DTG** Reduced concentration of AI ETR**+MVC** Decrease in MVC concentration** SQV** and DRV** non-RTV enhanced** Low efficacy and high likelihood of developing resistance MVC** Should not be administered without determination of HIV R5 tropism (predominance of CCR5 tropic population [102] (4C) TDF** + ATV** non-reinforced RTV** Possibly decreased efficiency ABC** with EFV**, RPV (including as part of PKD) with VL >100,000 copies/ml Possibly decreased efficiency ABC** + 3TC**, and ZDV** + 3TC** Should not be given to patients with chronic HBV without a second HBV drug due to possible HBV resistance to 3TC in recommended that physicians responsible for monitoring HIV-infected people should first prescribe drugs of preferred ART regimens (Table 2), if it is impossible to prescribe them, alternative regimens and regimens used in special cases [5,9,10,11,37,109112, 131-139,140-143] (5C) .

First-line ART regimens for adults by ART preference Preferred Scheme Alternative schemes Special cases TDF** + 3TC** + EFV** [37,109,110,111,112] TDF** + FTC + EFV** [37,109,110,111,112,131,132] TDF** + 3TC** + DTG** [37,133,134,135] TDF** + FTC + DTG** [37,133,134,135] TDF** + 3TC +ESV** [136, 137, 138] TDF** + FTC + ESV**[136, 137, 138] ABC** + 3TC** + DTG** [37,139] TDF** + 3TC** + EFV**400 [37,135,140,141] schemes that include TDF**, ABC**, ZDV**, F-AZT**, 3TC**, FTC, [5,9,10,11,37] ritonavir-boosted protease inhibitors (ATV** ATV**+r**, LPV/r**, DRV**+r**), RAL** RPV/TDF/FTC**, ETR**, [5,9,10,11,37] EVG/C/FTC/TAF (listed for Vital and Essential Drugs for 2021) [37,133,142,143] BIC/FTC/TAF, DOR [37,133,142,143] recommended to preferentially use ARVP as part of fixed dose combinations (FDC) to improve adherence to therapy, ease of use [127] (2A) recommended that physicians responsible for the care of HIV-infected patients use their preferred ART regimens when starting first-line ART (starting ART): tenofovir** in combination with lamivudine** plus efavirenz** [37,109,110,111,112] (2A) tenofovir** in combination with emtricitabine plus efavirenz** [37,109,110,111,112,131,132] (2A) tenofovir** plus lamivudine** plus dolutegravir** [37,133,134,135] (3B) tenofovir** plus emtricitabine plus dolutegravir** [37,133,134,135] (1A) tenofovir** plus lamivudine** plus elsulfavirine** [ 136, 137, 138] (4C) tenofovir** plus emtricitabine plus Buy VigRX Plus 60caps online - Herbals elsulfavirin** [136, 137, 138] (4C) Comments: Preferred regimens may also be given to patients with active TB (when prescribing dolutegravir** in patients with TB who are on rifampicin**, a dose increase of dolutegravir** at a dose of 50 mg twice daily is required when use with rifampicin**) and chronic hepatitis B; recommended that physicians responsible for monitoring HIV-infected patients use TDF ** with caution in patients with renal insufficiency: if creatinine clearance decreases to 30-49 ml / min, a dose adjustment is necessary; with a decrease in creatinine clearance below 30 ml / min, it is possible to prescribe TDF ** only if there are no alternatives, see table.