Which regimens are preferred by the DHHS guidelines for treatment-naive patients with HIV infection?

Updated: Jul 27, 2020
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Current DHHS guidelines list the below regimens as preferred in most treatment-naive patients. [11]

INSTI-based regimens are as follows:

  • Bictegravir/tenofovir alafenamide/emtricitabine (single-tablet regimen)
  • Dolutegravir/abacavir/lamivudine (single-tablet regimen) - Only for patients who are HLA-B*5701–negative and without chronic hepatitis B virus (HBV) coinfection (In women of childbearing age, discuss the risks and benefits of prescribing dolutegravir around the time of conception, including the low risk of neural tube defects [NTDs] and the relative lack of information regarding the safety of using other commonly prescribed antiretrovirals [ARVs].)
  • Dolutegravir plus (emtricitabine or lamivudine) plus (tenofovir alafenamide or tenofovir disoproxil fumarate)
  • Raltegravir plus (emtricitabine or lamivudine) plus (tenofovir alafenamide or tenofovir disoproxil fumarate)
  • Dolutegravir plus lamivudine - Except in individuals with HIV RNA of more than 500,000 copies/mL, persons with HBV coinfection, or patients in whom ART is to be started before the results of HIV genotypic resistance for reverse transcriptase or HBV testing are available

The PI/r–based regimen is darunavir/ritonavir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine).

HIV-2 is intrinsically resistant to NNRTIs and enfuvirtide.

To address individual patient characteristics and needs, the Panel also provides a list of Recommended Initial Regimens in Certain Clinical Situations. [11]

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