2
Selecting a Treatment Regimen
Initiating Antiretroviral Therapy
Î Antiretroviral therapy (ART) is recommended for all HIV-infected
individuals, regardless of CD4 count, to reduce the morbidity and
mortality associated with HIV infection (A-I).
Î ART is also recommended for HIV-infected individuals to prevent
transmission of HIV (A-I).
Î When initiating ART, it is important to educate patients regarding
the benefits and considerations of ART, and to address strategies to
optimize adherence.
• On a case-by-case basis, ART may be deferred because of clinical and/or
psychosocial factors, but therapy should be initiated as soon as possible.
What to Start: Initial Combination Regimens for the
Antiretroviral-Naive Patient
Î An antiretroviral (ARV) regimen for a treatment-naive patient
generally consists of two nucleoside reverse transcriptase inhibitors
(NRTIs) in combination with a third active ARV drug from one of three
drug classes: an integrase strand transfer inhibitor (INSTI), a non-
nucleoside reverse transcriptase inhibitor (NNRTI), or a protease
inhibitor (PI) with a pharmacokinetic (PK) enhancer (booster)
(cobicistat or ritonavir).
Table 1a. Recommended Initial Regimens for Most People
with HIV
Recommended regimens are those with demonstrated durable virologic efficacy,
favorable tolerability and toxicity profiles, and ease of use.
INSTI + 2-NRTIs:
Î BIC/TAF/FTC
a
(A-I)
Î DTG/ABC/3TC
a
(A-I if HLA-B*5701 negative)
Î DTG + tenofovir
b
/FTC
a
(A-I for both TAF/FTC and TDF/FTC)
Î EVG/c/tenofovir
b
/FTC (A-I for both TAF/FTC and TDF/FTC)
Î RAL
c
+ tenofovir
b
/FTC
a
(A-I for TDF/FTC, A-II for TAF/FTC)
a
3TC may be substituted for FTC, or vice versa, if a non–fixed-dose NRTI combination is desired.
b
TAF and TDF are two forms of tenofovir 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.
c
RAL can be given as 400 mg bid or 1200 mg (two 600-mg tablets) once daily.
