Key Principles and Recommended Regimens for First-line Antiretroviral Therapy

  • Author: Paul E. Sax, MD (More Info)
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 11/12/21 (What's New)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4 | Table 5 | Table 6 | Table 7 | Table 8

Table 1. DHHS and IAS-USA: Recommended Antiretroviral Therapy Regimens for Treatment-Naive Patients[DHHS ART; IASUSA ART]

 

DHHS:
Recommended for Most People With HIV

IAS-USA:
Recommended for Most People With HIV

INSTI based

 

  • Dolutegravir/lamivudine*†† (only if HIV-1 RNA < 500,000 copies/mL, HBV negative, and resistance and HBV test results are available)
  • Dolutegravir/lamivudine*†† (only if HIV-1 RNA < 500,000 copies/mL, HBV negative, cell counts > 200 cells/mm3, and resistance and HBV test results are available)

NNRTI based

  • None
  • None

PI based

  • None
  • None

*Al++/Ca++/Mg++–containing antacids should be taken a minimum of 2 hours after or 6 hours before dolutegravir- or elvitegravir-containing regimens. Bictegravir/emtricitabine/tenofovir AF can be taken under fasting conditions 2 hours before Al++/Ca++/Mg++–containing antacids. Al++/Mg++–containing antacids are not recommended in combination with raltegravir.
Tenofovir DF is not recommended for individuals with creatinine clearance < 60 mL/min and tenofovir AF is not recommended in individuals with creatinine clearance < 30 mL/min or with severe liver impairment.
In patients who are HLA-B*5701 negative.
§Lamivudine can substitute for emtricitabine and vice versa if a non–fixed-dose NRTI combination is desired.
||Tenofovir DF and tenofovir AF are 2 forms of tenofovir approved by the FDA. Tenofovir AF has fewer bone and kidney toxicities than tenofovir DF, whereas tenofovir DF is associated with lower lipid levels. Safety, cost, and access are among the factors to consider when choosing between these drugs.
Tenofovir DF may be substituted for tenofovir AF if tenofovir AF is not available for the patient.
**Fewer long-term data available for bictegravir vs dolutegravir.
††See section below on important considerations for use in women during conception related to reports of potential dolutegravir teratogenicity.

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