A regimen should be individualized on the basis of virologic efficacy (suppression of viral load to less than 50 copies per mL), toxicity, pill burden, dosing frequency, drug-drug interaction potential, drug resistance testing results, and co-morbid conditions (such as kidney disease, hepatitis B or C, etc.). See details about the strength of the recommendations in the DHHS documents online.
Patients new to antiretroviral therapy should start on one of three types of combination regimens:
|INSTI-based||Isentress (RAL) + Truvada (FTC/TDF)3|
|Preferred for Pregnant Women|
|PI-based||Kaletra (LPV/r) (twice daily) + Combivir (3TC/ZDV)3
boosted Reyataz (ATV/r) (once daily) + Combivir (3TC/ZDV)3
Based on personal characteristics and needs, in some instances, an alternative regimen may actually be a preferred regimen for an individual.
Kaletra (LPV/r) (once or twice daily) + Epzicom (ABC/3TC)3,4 or Truvada (TDF/FTC)3
|INSTI-based||Isentress (RAL) + Epzicom (ABC/3TC)3,4
|Other Antiretroviral Regimens|
Regimens that may be selected for some patients but are less satisfactory than preferred or alternative regimens.
|NNRTI-based||Edurant (RPV) + Combivir (3TC/ZDV)3
Sustiva (EFV) + Combivir (3TC/ZDV)3
Viramune (NVP2) + Combivir (3TC/ZDV)3 or Epzicom (ABC/3TC)3,4 or Truvada (FTC/TDF)3
boosted Invirase (SQV/r) + Combivir (3TC/ZDV)3, or Epzicom (ABC/3TC)3,4 or
|INSTI-based||Isentress (RAL) + Combivir (3TC/ZDV)3|
|CCR5 Antagonist-based regimen|
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. Section accessed February 6, 2013; Tables 5a and 5b.
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Accessed February 6, 2013; Table 5.