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:
- Integrase Strand Transfer Inhibitor-Based Regimens:
- Dolutegravir/abacavir/lamivudinea—only 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
- 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.