Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Initial Combination Regimens for the Antiretroviral-Naive Patient

On July 14, 2016, one of the most recognized set of written recommendations for how to treat individuals who are infected with HIV, “The U.S. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents”, was updated to present what is hoped to be new and improved information about treatment.

One of the most recognized components of the guidelines is the section on, “Initial Combination Regimens for the Antiretroviral-Naive Patient”, commonly called—“What to Start”!!! In the July 14th update of the guidelines, several changes were noted. These changes were primarily due to the recent approval by the FDA of 3 fixed-dose combination medications containing tenofovir alafenamide (an oral prodrug of tenofovir) and emtricitabine (TAF/FTC). According to the panel of experts who contributed to the writing of the updated guidelines, “The addition of TAF/FTC to these recommendations is based on data from comparative trials demonstrating that TAF-containing regimens are as effective in achieving or maintaining virologic suppression as tenofovir disoproxil fumarate (TDF)-containing regimens and with more favorable effects on markers of bone and renal health.” In other words, they work as well as the old Tenofovir based medicine with less chance of bad side effects. That’s o.k. with me, but based on my passed experience with HIV treatment, let’s not count the chickens before they hatch!!! We will follow the outcomes over time.

I believe it is important that we continue to recognize that each patient is different, and based on individual patient characteristics and needs, there are Alternative treatment regimens which may be the best regimen for a particular patient. Yes, my observation has been that most patients do well with one of the current six recommended regimens, however, Given the many excellent options for initial therapy, we should choose the regimen which best fits each patient.