Fast Five Quiz: HIV Antiretroviral Therapy

Jason F. Okulicz, MD


September 11, 2020

The initial ART regimen for a treatment-naive patient generally consists of two NRTIs, usually abacavir-lamivudine (ABC/3TC) or either tenofovir alafenamide-emtricitabine (TAF/FTC) or tenofovir disoproxil fumarate-emtricitabine (TDF/FTC), plus a drug from one of three drug classes: an INSTI, an NNRTI, or a boosted PI. As shown in clinical trials and by retrospective evaluation of cohorts of patients in clinical care, this strategy for initial treatment has resulted in suppression of HIV replication and CD4 count increases in most persons with HIV. Additional data now support the use of the two-drug single-tablet regimen DTG plus 3TC for initial treatment of people with HIV. There are currently two single-tablet regimens that include an INSTI plus two NRTIs. Boosted PI-based regimens are recommended only in certain clinical situations because they have greater potential for drug interactions than regimens anchored by unboosted INSTIs. It should also be noted that ABC should only be prescribed for individuals who are HLA-B*5701 negative and without chronic hepatitis B virus (HBV) coinfection. The two-drug combination of DTG plus 3TC is not recommended as initial therapy for individuals with HIV RNA > 500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing or HBV testing are available.

For more information, refer to the HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.


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