DHHS Guidelines for people starting HIV therapy for the first time

DHHS recommends starting antiretroviral therapy (ART) as soon as possible after HIV is diagnosed, regardless of CD4 count. Most people starting HIV treatment for the first time (treatment-naïve) should take one of the following: Biktarvy; Dovato; Triumeq; Tivicay plus Descovy or Truvada; or Isentress HD or Isentress plus Descovy or Truvada. Go to aidsinfo.nih.gov for more information.

Rating of recommendations

A: Strong

B: Moderate

C: Optional

Rating of evidence

1: Data from randomized controlled trials.

2: Data from well-designed non-randomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies, or regimen comparisons from randomized switch studies.

3: Expert opinion.

Key to acronyms

3TC: lamivudine

ABC: abacavir

ART: antiretroviral therapy

ARV: antiretroviral

ATV: atazanavir

ATV/c: atazanavir/cobicistat

ATV/r: atazanavir/ritonavir

BIC: bictegravir

CD4: CD4 T lymphocyte, “T cell”

DOR: doravirine

DRV: darunavir

DRV/c: darunavir/cobicistat

DRV/r: darunavir/ritonavir

DTG: dolutegravir

EFV: efavirenz

EVG: elvitegravir

EVG/c: elvitegravir/cobicistat

FDA: Food and Drug Administration

FTC: emtricitabine

HLA: human leukocyte antigen

INSTI: integrase strand transfer inhibitor

NNRTI: non-nucleoside reverse transcriptase inhibitor

NRTI: nucleoside reverse transcriptase inhibitor

PI: protease inhibitor

RAL: raltegravir

RPV: rilpivirine

STR: single-tablet regimen

TAF: tenofovir alafenamide

TDF: tenofovir disoproxil fumarate

Note: The following are available as co-formulated drugs  (Not a complete list)

Cimduo or Temixys: 3TC/TDF

Epzicom: ABC/3TC

Evotaz: ATV/c

Biktarvy: BIC/FTC/TAF

Delstrigo: DOR/3TC/TDF

Prezcobix: DRV/c

Symtuza: DRV/c/FTC/TAF

Dovato: DTG/3TC

Triumeq:  DTG/ABC/3TC

Symfi Lo: EFV 400 mg/3TC/TDF

Symfi: EFV 600 mg/3TC/TDF

Atripla: EFV/FTC/TDF

Genvoya: EVG/c/FTC/TAF

Stribild: EVG/c/FTC/TDF

Descovy: FTC/TAF

Truvada: FTC/TDF

Odefsey: RPV/FTC/TAF

Complera: RPV/FTC/TDF


1.  Lamivudine (3TC) may substitute for emtricitabine (FTC) or vice versa.

2.  Except for individuals with pre-treatment HIV RNA greater than 500,000 copies/mL; who are known to have active hepatitis B virus (HBV) coinfection; or who will initiate ART before results of HIV genotype testing for reverse transcriptase or HBV testing are available.


Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are two forms of tenofovir that are approved by the Food and Drug Administration. TAF has fewer bone and kidney toxicities than TDF, while TDF is associated with lower lipid levels. Safety, cost, and access are among the factors to consider when choosing between the two.

raltegravir (RAL) can be given as RAL 400 mg twice daily or RAL 1,200 mg (two 600 mg tablets) once daily.