Understanding the Details of HIV Treatment

Choosing Your First and Maybe Second Regimen

The most powerful and long-lasting activity against HIV comes from a person's first regimen if taken properly. Some experts believe that the best first line strategy is to take the most potent regimen. The longer a person can stay on it without major side effects or drug resistance, the better. Boosted PIs (those taken with a small dose of Norvir) and Sustiva are considered the most potent, though PIs tend to be longer-lasting.

When a person's viral load remains undetectable for at least one year on treatment, it usually remains that way for at least another two years, assuming they take their meds as prescribed. This is true for almost any regimen used.

It's less clear how much the choice of a first regimen will affect how well a second one will work. In most cases, people who start with a PI will likely be able to use Sustiva successfully in the second regimen, and may also be able to use other PIs. Similarly, people who start with Sustiva can usually switch to a PI.

Other experts believe that saving potent and longer lasting meds for second regimens is a better strategy, and that starting treatment with an NNRTI or even an integrase inhibitor is preferable. NNRTIs may also cause fewer long-term changes in cholesterol, triglycerides or body fat compared to PIs, though study data are mixed.

Planning your second regimen ahead of time can be useful. For instance, you may start one regimen, but then find that the drugs don't work as well as you had hoped. You can then proceed to the second with more ease.

Recommended Regimens for First Line Treatment

The Guidelines list "preferred" and "alternative" HIV regimens. Research shows that "preferred" regimens are potent, better tolerated and easier to take. "Alternative" regimens are second choices but may work just as well.