Initial Antiretroviral Regimens
The first antiretroviral drug regimen used to treat a previously treatment-naïve HIV-infected patient.
Although there are many possible choices for initial antiretroviral therapy (ART) in an HIV-infected patient, only a small subset of the potential options are now recommended in treatment guidelines used in most resource-rich settings. Recommendations are based on a combination of efficacy, safety, tolerability, convenience, and in some cases cost. This review will focus primarily on regimens recommended and used in the United States, where cost has traditionally not been a criterion for guideline selection. However, that may change as less expensive generic drugs become available.
US guidelines include those from the Department of Health and Human Services (DHHS), which are updated approximately once a year (Panel on Antiretroviral Guidelines for Adults and Adolescents 2015), and those from the International Antiviral Society (IAS-USA), updated every 2 years...
KeywordsChronic Kidney Disease Tenofovir Disoproxil Fumarate Immune Reconstitution Inflammatory Syndrome Recommended Regimen NRTI Backbone
- Cahn P, Andrade-Villanueva J, Arribas JR, et al. Dual therapy with lopinavir and ritonavir plus lamivudine versus triple therapy with lopinavir and ritonavir plus two nucleoside reverse transcriptase inhibitors in antiretroviral-therapy-naïve adults with HIV-1 infection: 48 week results of the randomised, open label, non-inferiority GARDEL trial. Lancet Infect Dis. 2014;14:572–80.CrossRefPubMedGoogle Scholar
- Clumeck N, Molina JM, Henry K, et al. A randomized, double-blind comparison of single-tablet regimen elvitegravir/cobicistat/emtricitabine/tenofovir DF vs ritonavir-boosted atazanavir plus emtricitabine/tenofovir DF for initial treatment of HIV-1 infection: analysis of week 144 results. J Acquir Immune Defic Syndr. 2014;65:e121–4.CrossRefPubMedGoogle Scholar
- Lennox JL, Landovitz RJ, Ribaudo HJ, et al. Efficacy and tolerability of 3 nonnucleoside reverse transcriptase inhibitor sparing antiretroviral regimens for treatment-naive volunteers infected with HIV-1: a randomized, controlled equivalence trial. Ann Intern Med. 2014;161:461–71.PubMedCentralCrossRefPubMedGoogle Scholar
- Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0. Accessed 1 June 2015.
- Raffi F, Babiker AG, Richert L, et al. Ritonavir-boosted darunavir combined with raltegravir or tenofovir-emtricitabine in antiretroviral-naive adults infected with HIV-1: 96 week results from the NEAT001/ANRS143 randomised non-inferiority trial. Lancet. 2014;384:1942–51.CrossRefPubMedGoogle Scholar
- Wohl DA, Cohen C, Gallant JE, et al. A randomized, double-blind comparison of single tablet regimen elvitegravir/cobicistat/emtricitabine/tenofovir DF versus single tablet regimen efavirenz/emtricitabine/tenofovir DF for initial treatment of HIV-1 infection: analysis of week 144 results [letter]. J Acquir Immune Defic Syndr. 2014;65:3118–21.CrossRefGoogle Scholar