What is an easy way to remember antiretrovirals (AntiRetroViral medications) in Human Immunodeficiency Virus (HIV) care?

Easy Ways to Remember Antiretroviral Medications in HIV Care

The most effective way to remember antiretroviral medications is to organize them by drug class and use mnemonic devices that highlight their mechanisms of action and key characteristics. 1

Classification of Antiretrovirals by Drug Class

1. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

• Mnemonic: "The TIDE of nucleosides"
  • T: Tenofovir (TAF or TDF) - "Bone and kidney protector" (TAF better than TDF)
  • I: Lamivudine (3TC) - "Well-tolerated companion"
  • D: Didanosine (ddI) - "Older agent, rarely used now"
  • E: Emtricitabine (FTC) - "Partner to tenofovir"
  • Also includes: Abacavir (ABC), Zidovudine (AZT)

2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Mnemonic: "NEW RIDE"
  • Nevirapine
  • Efavirenz
  • Rilpivirine
  • Delavirdine
  • Etravirine

3. Protease Inhibitors (PIs)

• Mnemonic: "SAND RAT"
  • Saquinavir
  • Atazanavir
  • Nelfinavir
  • Darunavir
  • Ritonavir (often used as booster, indicated by "/r")
  • Amprenavir
  • Tipranavir

4. Integrase Strand Transfer Inhibitors (InSTIs)

• Mnemonic: "BRED"
  • Bictegravir
  • Raltegravir
  • Elvitegravir
  • Dolutegravir

5. Entry Inhibitors

• CCR5 Antagonist: Maraviroc
• Fusion Inhibitor: Enfuvirtide (T-20)

Remembering Preferred Regimens

First-Line Regimen Structure

• 2 NRTIs + 1 third agent (usually an InSTI) 1
• Most common backbone: Tenofovir (TAF or TDF) + Emtricitabine (FTC) or Abacavir (ABC) + Lamivudine (3TC)

Key Fixed-Dose Combinations

• Mnemonic: "BIKTARVY Takes Triumeq Down"
  • Bictegravir/FTC/TAF (Biktarvy)
  • TDF/FTC/Efavirenz (Atripla)
  • TAF/FTC/Rilpivirine (Odefsey)
  • Dolutegravir/ABC/3TC (Triumeq)

Clinical Pearls for Remembering Key Characteristics

1. InSTIs (BRED): First-line agents with high barrier to resistance (especially dolutegravir and bictegravir) 1

2. NRTIs (TIDE):

   • TAF has less renal/bone toxicity than TDF 1
   • Abacavir requires HLA-B*5701 testing before use 2

3. PIs:

   • All need boosting except nelfinavir
   • High barrier to resistance but more side effects 3
   • Remember as "Power with a Price"

4. NNRTIs:

   • Low barrier to resistance
   • Efavirenz: "Dreams and dizziness" (CNS side effects)
   • Rilpivirine: "Food-dependent friend" (must take with food)

Remembering by Treatment Scenarios

1. Treatment-naïve patients: InSTI + 2 NRTIs 1

   • Example: Dolutegravir + TAF/FTC

2. HIV/HBV co-infection: Must include TDF or TAF + FTC/3TC 1

3. Renal impairment: Avoid TDF, prefer TAF 1

4. Pregnancy: Historically efavirenz or raltegravir-based regimens

Adherence Support Strategies

Remember that fixed-dose combinations improve adherence by reducing pill burden 3. When discussing medications with patients, focus on:

• Once-daily dosing when possible
• Fixed-dose combinations
• Medication timing with daily activities
• Side effect profiles

Pitfalls to Avoid

1. Never use single agents or dual therapy unless specifically recommended (e.g., dolutegravir/rilpivirine) 1

2. Avoid monotherapy with PIs or InSTIs as this leads to resistance 3

3. Always check for drug-drug interactions, especially with PIs and NNRTIs

4. Remember that some antiretrovirals require HLA testing (abacavir) or tropism testing (maraviroc) before use 2

By organizing antiretrovirals by class and using these mnemonics, healthcare providers can more easily remember these medications and their key characteristics for optimal HIV care.