Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

 Written by: The Panel on Antiretroviral Guidelines for Adults and Adolescents

 

Panel’s Recommendations Regarding Initial Combination Regimens for the Antiretroviral-Naive Patient

  • 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).
  • The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) classifies the following regimens as Recommended regimens for antiretroviral therapy (ART)-naive patients:
  1. Integrase Strand Transfer Inhibitor-Based Regimens:
    • Dolutegravir/abacavir/lamivudineaonly for patients who are HLA-B*5701 negative
    • Dolutegravir plus either tenofovir disoproxil fumarate/emtricitabinea or tenofovir alafenamide/emtricitabine
    • Elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine
    • Elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine
    • Raltegravir plus either tenofovir disoproxil fumarate/emtricitabineaor tenofovir alafenamide/emtricitabine
  2. Protease Inhibitor-Based Regimens:
    • Darunavir/ritonavir plus either tenofovir disoproxil fumarate/emtricitabinea or tenofovir alafenamide/emtricitabine
  • On the basis of individual patient characteristics and needs, an Alternative regimen or, less frequently, an Other regimen, may be the optimal regimen for a particular patient.
  • Given the many excellent options for initial therapy, selection of a regimen for a particular patient should be guided by factors such as virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance testing results, comorbid conditions, and cost.

 

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