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 October 2017.
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 a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two NRTIs. (Drugs classes and regimens within each class are listed in alphabetical order.)
Recommended Treatment Combinations for Most People with HIV
Recommended regimens are drug combinations that have been shown to maintain viral load suppression, are generally well tolerated with limited toxicities, and are considered easy to use.
- Genvoya (elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine)
- Isentress (raltegravir) AND EITHER:
- Stribild (elvitegravir + cobicistat + tenofovir disoproxil + emtricitabine)
- Tivicay (dolutegravir) AND EITHER:
- Triumeq (dolutegravir + abacavir + lamivudine)1
Recommended Treatment Combinations in Certain Situations
These regimens are effective and tolerable, but have some disadvantages when compared with the regimens listed above, or have less supporting data from the best-designed clinical trials. However, in certain clinical situations,* one of these regimens may be preferred.
- Atripla (efavirenz + tenofovir disoproxil + emtricitabine)
- Complera (rilpivirine + tenofovir disoproxil + emtricitabine)2
- Odefsey (rilpivirine + tenofovir alafenamide + emtricitabine)2
- Sustiva (efavirenz) AND EITHER:
- Evotaz (atazanavir + cobicistat) AND EITHER:
- Prezcobix (darunavir + cobicistat) AND EITHER:
- Prezista (darunavir) PLUS low-dose Norvir (ritonavir) AND EITHER:
- Prezcobix (darunavir + cobicistat) AND generic abacavir + lamivudine1,2
- Prezista (darunavir) + low-dose Norvir (ritonavir) AND generic abacavir + lamivudine1,2
- Reyataz (atazanavir) PLUS low-dose Norvir (ritonavir) AND EITHER:
Regimens to Consider when the NRTIs abacavir or tenofovir cannot be used
- Prezista (darunavir) + low-dose Norvir (ritonavir) AND Isentress (raltegravir)2
- Kaletra (lopinavir/ritonavir) AND generic lamivudine
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. Abacavir and lamivudine, originally coformulated under the brand name Epzicom, is now available as a generic combination. 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.
With respect to tenofovir alafenamide (TAF) and tenofovir disoproxil (TDF), both are approved by the FDA. 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 these drugs.
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: October 21, 2017