Version June 2024
| Regimen selection from the options below should be individualized based upon comorbid conditions (eg, HBV, kidney disease, osteoporosis), childbearing potential, pill burden, drug-drug interactions, and results of resistance testing. | |
| Preferred regimens (listed alphabetically) | Comments: |
| For most persons with HIV who are ready to start treatment, one of these regimens can be prescribed on the same day of the confirmed diagnosis or at their initial clinic visit, even if all baseline laboratory test results haven't returned. Same-day initiation of ART has been associated with improved virologic outcomes and improved retention in care. However, a brief delay in treatment is usually indicated in patients who cannot take one of these tenofovir-based regimens (eg, patients with severely reduced kidney function) or if there is concern for certain active opportunistic infections (eg, tuberculosis, cryptococcal meningitis). |
| Alternative regimens (agents within class listed alphabetically) | Comments: |
INSTI-based regimens
| Abacavir is contraindicated in patients who test positive for HLA-B*5701 and should be avoided if HLA-B*5701 testing cannot be performed. Antiretroviral medications that require a boosting agent (eg, ritonavir or cobicistat) are associated with the greatest risk of drug interactions. |
PI-based regimens
| Antiretroviral medications that require a boosting agent (eg, ritonavir or cobicistat) are associated with the greatest risk of drug interactions. |
NNRTI-based regimens
| |
Two-drug regimens
| Data support the use of dolutegravir-lamivudine in select treatment-naïve patients who have an HIV load <500,000 copies/mL, no evidence of chronic HBV infection, and no evidence of transmitted resistance to NRTIs or INSTIs (if INSTI resistance testing was obtained as part of the initial evaluation). Patients should not take concurrent medications that may significantly reduce the levels of either antiretroviral agent and should ideally have a CD4 count >200 cells/microL. There is less experience with other two-drug regimens (eg, boosted-darunavir plus either lamivudine or dolutegravir), and these regimens should generally be avoided. |
ART: antiretroviral therapy; eGFR: estimated glomerular filtration rate; HBV: hepatitis B virus; INSTI: integrase strand transfer inhibitor; NNRTI: non-nucleoside reverse transcriptase inhibitor; NRTI: nucleoside reverse transcriptase inhibitor; PI: protease inhibitor.
¶ Refer to the UpToDate topics that discuss HIV in pregnancy for regimens used to treat pregnant women.
Δ Tenofovir alafenamide-emtricitabine can be used in patients with moderately reduced kidney function (eGFR ≥30 min/mL/1.73 m2) but should be avoided in those with severely reduced kidney function not on hemodialysis.
◊ If tenofovir alafenamide is not available or should not be used (eg, to avoid drug interactions with rifamycins or certain antiseizure medications), tenofovir disoproxil fumarate-emtricitabine is an effective and well-tolerated choice for most patients with normal kidney function (eGFR ≥60 min/mL/1.73 m2) and for those without evidence of bone disease.
§ Pharmacologically boosted darunavir is better tolerated than other PIs. However, it should be used with caution in patients with sulfonamide allergy. When darunavir is used, we prefer a tenofovir-containing nucleoside combination rather than one that uses abacavir-lamivudine, as there is more experience with this regimen. If a PI is strongly desired and darunavir cannot be used, pharmacologically boosted atazanavir plus tenofovir (tenofovir alafenamide or tenofovir disoproxil fumarate)-emtricitabine can be administered.
¥ Darunavir is available in two coformulated tablets with cobicistat: darunavir-cobicistat and darunavir-cobicistat-emtricitabine-tenofovir alafenamide.
‡ Doravirine is available in a coformulated tablet with lamivudine and tenofovir disoproxil fumarate.
† This regimen should be avoided in patients with a CD4 count <200 cells/microL and/or an HIV RNA ≥100,000 copies/mL. In addition, it should be taken with food, and proton pump inhibitors should be avoided.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
