Stribild, a once-daily, single-pill regimen, and Tivicay, a recently approved integrase inhibitor, are now part of the list of "preferred" HIV medications in the official U.S. HIV treatment guidelines. The promotion of both drugs was announced on Oct. 30 by AIDSinfo, an information service of the U.S. Department of Health and Human Services (HHS), which produces the guidelines via a nationwide panel of experts.
The HHS guidelines were last updated in February 2012. Until last week, only four regimens had been listed as "preferred" for people taking HIV meds for the first time:
- Atripla (a single pill containing three HIV meds: Sustiva [efavirenz, Stocrin], Viread [tenofovir] and Emtriva [emtricitabine, FTC])
- Norvir (ritonavir) plus Reyataz (atazanavir) plus Truvada (tenofovir/FTC)
- Norvir plus Prezista (darunavir) plus Truvada
- Isentress (raltegravir) plus Truvada
Over the past year, however, research has increasingly shown that Stribild, which was approved in August 2012, and Tivicay, which got the green light in August 2013, can be just as potent, and just as safe, as those four options. So, last week, these three regimens were added to the "preferred" list:
- Stribild (a single pill containing four HIV meds: cobicistat, elvitegravir, Emtriva and Viread)
- Tivicay (dolutegravir) plus Epzicom (abacavir/3TC, Kivexa)
- Tivicay plus Truvada
The changes highlight the rise of integrase inhibitors as an established, reliable family of HIV meds for first-line treatment. Elvitegravir, Isentress and Tivicay are all members of this relatively new drug class, which has greatly expanded in number in recent years.
The HHS guidelines panel designates regimens as "preferred" based on its assessment that, from the research available, the drugs have been reliably shown to work extremely well, cause few side effects and are easy to take compared to other HIV treatment regimens.
Now that we have seven different "preferred" regimens, that critical question -- "What the heck do I start HIV treatment with?" -- looks more complicated than ever. The answer will usually come down to very specific factors that a person with HIV and his or her clinician need to discuss: the risk of specific side effects, potential interactions with other (non-HIV) medications the person may be taking, number and timing of pills, mental health issues and current HIV viral load, just to name a few. Our growing number of HIV treatment options makes close communication between HIV-positive people and their care providers more important than ever.
Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.
Follow Myles on Twitter: @MylesatTheBody.