Most people starting HIV treatment for the first time (treatment-naïve) should take one of the following:
- Tivicay plus Descovy or Truvada
- Isentress HD or Isentress, plus Descovy or Truvada
In certain clinical (health) situations, first-time folks may take one of the following regimens. They are effective and tolerable but have some disadvantages when compared with the regimens listed above or have less supporting data from randomized clinical trials.
- Symtuza; Prezcobix or Prezista plus Norvir, with Descovy, Truvada, or Epzicom
- Delstrigo; or Pifeltro plus Descovy
- Evotaz or Reyataz plus Norvir, with Descovy, Truvada, or Epzicom
- Odefsey or Complera
- Genvoya or Striblid
- Atripla; Sustiva plus Descovy; or Symfi or Symfi Lo
- Isentress or Isentress HD, plus Epzicom
That’s according to HIV treatment guidelines from the U.S. Department of Health and Human Services (DHHS).
Lots of people, however, are not taking HIV therapy for the first time; for example, people who are on therapy and virally suppressed may choose to switch to another regimen for improved tolerability or to avoid drug interactions. The guidelines have lots to say about that and other situations.
A more detailed list
An antiretroviral (ARV) regimen for a treatment-naïve individual is usually made up of two nucleoside reverse transcriptase inhibitors (NRTIs) in combination with a third active ARV drug from one of three drug classes: an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with a pharmacokinetic (PK) enhancer (also known as a booster; the two drugs used for this purpose are cobicistat and ritonavir). (See “Rising to the Occasion.”)
A pregnancy test should be performed for those of childbearing potential prior to the initiation of INSTI therapy.
A regimen should be individualized on the basis of virologic efficacy (suppression of viral load to less than 50 copies per mL), toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance testing results, comorbid conditions (such as kidney disease, hepatitis B or C, etc.), and cost. More details including recommendations for treatment-experienced individuals and those for pregnant women are available online. Preliminary data have raised concerns about an increased risk of neural tube defects in infants born to people who were receiving dolutegravir (DTG) at the time of conception. Before prescribing DTG or another INSTI, refer to Table 6b in the guidelines for specific recommendations on initiating these drugs as part of initial therapy.
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