Which HIV Treatment Regimen Should You Start With?

(Credit: NIAID)

We have dozens of different medications to treat HIV. How the heck is anyone supposed to figure out which are the right drugs for them?

Here's the good news: Despite the huge number of HIV treatment options that exist today, we know a lot about each of them. Thanks to years of rigorous scientific research, we have a solid understanding of how well each HIV medication works, what sorts of side effects it can cause (and how often), and what interactions it might have with other medications. We also know a great deal about which combinations of HIV meds will work best together as a treatment regimen -- as well as which regimens might be the best option for specific groups of people, such as people who are pregnant or people with certain chronic health conditions (e.g., heart problems, hepatitis, or mental illness).

Still, the fact is there are a whole lot of HIV medications to choose from, and figuring which meds are best can feel overwhelming. That's where HIV treatment guidelines and knowledgeable HIV care providers come in: Both are your partners in finding a regimen that works best for you.

What Do HIV Treatment Guidelines Say About What to Start Treatment With?

In the U.S., our most reputable source of HIV treatment recommendations comes from the U.S. Department of Health and Human Services (HHS). The department convenes a panel of HIV treatment experts -- a group of people that includes many of the top HIV care providers and community advocates in the country -- who review recommendations regularly and tend to update them at least once every year.

The official name for these recommendations is "Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV," but they're often referred to as just the HHS HIV treatment guidelines. They are the country's go-to resource for HIV care providers on what medications to prescribe to people living with HIV.

The HHS HIV treatment guidelines were last updated on Oct. 25, 2018. They recommend the following six regimens as the best first-line HIV treatment options:

• Biktarvy (a once-daily pill containing three HIV meds: bictegravir, emtricitabine, and tenofovir alafenamide)
• Triumeq (a once-daily pill containing three HIV meds: abacavir, dolutegravir, and lamivudine)
• A two-pill regimen of Tivicay (dolutegravir) plus Truvada (which contains two HIV meds, emtricitabine and tenofovir disoproxil fumarate)
• A two-pill regimen of Tivicay plus Descovy (which contains two HIV meds, emtricitabine and tenofovir alafenamide)
• A two-pill regimen of Isentress (raltegravir) plus Truvada
• A two-pill regimen of Isentress plus Descovy

The HHS expert panel gives its highest recommendation to these six regimens based on research showing that they give most people the best possible chance to keep HIV at bay. They're powerful, they're not likely to cause serious side effects, and they're easy to use -- meaning they don't involve taking a lot of pills, they're easy to store, they don't interact with most other drugs, and they don't come with any rules around taking them with or without food (either is fine).

This list helps narrow your options down, but it still leaves plenty of questions. How do you choose between these six recommended regimens? What if you have a health condition or some other issue that might prevent one or more of those regimens from working correctly? What else do you need to know about how to make sure your first HIV treatment regimen is successful and continues to work indefinitely?

That's where a knowledgeable HIV care provider comes in extremely handy.

How Can My HIV Care Provider Help Me Choose What to Start HIV Treatment With?

The person who prescribes your HIV meds is your health care partner. The same goes for the team of professionals around them, including nurses, physician assistants, lab technicians, and case managers -- as the saying goes, it takes a village, and that's as true for HIV treatment as anything else.

It's the job of a good HIV care provider to stay up to date on the HHS guidelines and other information they may need to help you make decisions about your health. When it comes to choosing your first HIV treatment regimen, they'll help whittle down your potential options by:

• Asking you about your preferences, hopes, and fears
• Testing your blood for any signs of HIV drug resistance or HIV medication allergies
• Checking your key HIV labs to measure the health of your immune system
• Determining whether you have any health conditions that might result in a change in which HIV meds are best for you

If you need help finding a good HIV care provider, check out this resource from AIDSinfo on how to locate HIV treatment services near you.

Where Can I Turn for More Information About Starting HIV Treatment?

We recommend these fact sheets:

• "Starting HIV Treatment" from The Well Project
• "HIV Treatment Fact Sheet" from U.S. Centers for Disease Control and Prevention
• "HIV Treatment: The Basics" from AIDSinfo

Also check out these great personal and expert perspectives:

• "Is Your HIV Care Provider the Right Fit for You?"
• "5 Tips to Bridge the Gap With Your HIV Health Care Team"
• "17 Top Questions About Starting HIV Treatment"

Myles Helfand is the executive editor and general manager of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.