The following information is based on the most recent version of the U.S. Department of Health and Human Services’ Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, last updated in July 2016.

For HIV-positive adolescents and adults starting HIV treatment for the first time, a typical regimen contains one integrase inhibitor (INSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs), OR a protease inhibitor (PI) plus two NRTIs, OR an  non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two NRTIs. (Drugs classes and regimens within each class are listed in alphabetical order.)

Recommended Treatment Combinations

INSTI-Based Regimens

  • Genvoya (elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine) OR Stribild (elvitegravir + cobicistat + tenofovir disoproxil + emtricitabine)
  • Isentress (raltegravir) AND Descovy (tenofovir alafenamide + emtricitabine) OR Truvada (tenofovir disoproxil + emtricitabine)
  • Tivicay (dolutegravir) AND Descovy (tenofovir alafenamide + emtricitabine) OR Truvada (tenofovir disoproxil + emtricitabine)
  • Triumeq (dolutegravir + abacavir + lamivudine)1

PI-Based Regimen

  • Prezista (darunavir) + low-dose Norvir (ritonavir) AND Descovy (tenofovir alafenamide + emtricitabine) OR Truvada (tenofovir + emtricitabine)


Alternative Treatment Combinations


These are regimens that are effective and tolerable and may be preferred for some people living with HIV. However, they may have potential disadvantages when compared with the Recommended regimens listed above or may have less data from clinical trials to guide their use.

NNRTI-Based Regimens

  • Atripla (efavirenz + tenofovir disoproxil + emtricitabine)
  • Complera (rilpivirine + tenofovir disoproxil + emtricitabine)2 OR Odefsey (rilpivirine + tenofovir alafenamide + emtricitabine)2
  • Sustiva (efavirenz) AND Descovy (tenofovir alafenamide + emtricitabine)

PI-Based Regimens

  • Evotaz (atazanavir + cobicistat) OR Reyataz (atazanavir) + low-dose Norvir (ritonavir) AND Descovy (tenofovir alafenamide + emtricitabine) OR Truvada (tenofovir disoproxil + emtricitabine) 
  • Prezcobix (darunavir + cobicistat) OR Prezista (darunavir) + low-dose Norvir (ritonavir) AND Epzicom (abacavir + lamivudine)1
  • Prezcobix (darunavir + cobicistat) AND Descovy (tenofovir alafenamide + emtricitabine) OR Truvada (tenofovir disoproxil + emtricitabine)

Other Treatment Combinations

These are regimens that are also effective and tolerable and may be preferred for some people living with HIV. However, they may have potential disadvantages when compared with the Recommended or Alternative regimens listed above or may have less data from clinical trials to guide their use. These include:

If viral load is below 100,000 copies and the HLA-B*5701 test is negative:

If tenofovir alafenamide (found in Genvoya, Odefsey, and Descovy), tenofovir disoproxil (found in Stribild, Complera, Atripla, and Truvada), or abacavir (found in Ziagen, Epzicom, and Triumeq) cannot be used:

Important notes:

1 Should only be used by people who test negative for HLA-B*5701, a genetic mutation that greatly increases the risk of a serious allergic reaction to abacavir
2 Should only used if pre-treatment viral load is below 100,000 copies/mL and CD4 count is higher than 200 cells/mm3

Some of these recommended drugs are available generically. The individual components of Epzicom (abacavir and lamivudine) are both available as generics as separate tablets. Generic lamivudine can also be used in place of emtricitabine (which is not available generically). This may require taking more pills, but the regimen should be no less effective.

While the DHHS Guidelines can seem a bit overwhelming, the experts responsible for making these recommendations stress a very important point: that selecting a drug regimen should be based on an HIV-positive person’s individual needs. In other words, an HIV-positive person may have specific needs with respect to a drug combination’s effectiveness (perhaps against drug-resistant virus), dosing schedule (the number of pills and the number of times each day pills need to be taken), side effects (some people may be more sensitive to certain adverse effects than others), drug interactions (some HIV drugs are difficult to combine with other medications HIV-positive people take), and other infections or illnesses (people with hepatitis B or hepatitis C may need to be treated with certain HIV drugs very carefully).

The DHHS also recommends the use of drug-resistance testing to help figure out which anti-HIV drugs should be used as first-time treatment. This is because some people are infected with drug-resistant strains of HIV that may limit certain anti-HIV drug treatment options, even in people starting treatment for the first time. To learn more about HIV drug resistance and drug-resistance testing, click here.

Above all, it is important that you take the correct dose of your medications every time you’re supposed to take them, exactly as prescribed by your health care provider or recommended by your pharmacist. This is called treatment adherence—you need to take your medications correctly if they are to keep you healthy. To learn more about treatment adherence, click here.

Last Revised: July 17, 2016