DHHS Guidelines for people starting HIV therapy for the first time
Feb 27, 2019

Most people starting HIV treatment for the first time (treatment naïve) should take one of the following: Biktarvy; Triumeq; Tivicay plus Descovy or Truvada; or Isentress HD or Isentress, plus Descovy or Truvada.

Rating of Recommendations

A: Strong
B: Moderate
C: Optional

Rating of Evidence
I: Data from randomized controlled trials
II: Data from well-designed non-randomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies, or regimen comparisons from randomized switch studies
III:        Expert opinion

Key to Acronyms

3TC: lamivudine
ABC: abacavir
ART: antiretroviral therapy
ARV: antiretroviral
ATV: atazanavir
ATV/c: atazanavir/cobicistat
ATV/r: atazanavir/ritonavir
BIC: bictegravir
CD4: CD4 T lymphocyte, “T cell”
DOR: doravirine
DRV: darunavir
DRV/c: darunavir/cobicistat
DRV/r: darunavir/ritonavir
DTG: dolutegravir
EFV: efavirenz
EVG: elvitegravir
EVG/c: elvitegravir/cobicistat
FDA: Food and Drug Administration
FTC: emtricitabine
HLA: human leukocyte antigen
INSTI: integrase strand transfer inhibitor
NNRTI: non-nucleoside reverse transcriptase inhibitor
NRTI: nucleoside reverse transcriptase inhibitor
PI: protease inhibitor
RAL: raltegravir
RPV: rilpivirine
STR: single-tablet regimen
TAF: tenofovir alafenamide
TDF: tenofovir disoproxil fumarate

NOTE: The following are available as co-formulated drugs
(Not a complete list)

Epzicom
ABC/3TC

Evotaz
ATV/c

Biktarvy
BIC/FTC/TAF

Delstrigo
DOR/3TC/TDF

Prezcobix
DRV/c

Symtuza
DRV/c/FTC/TAF

Triumeq
DTG/ABC/3TC

Symfi
EFV 600 mg/3TC/TDF

Atripla
EFV/FTC/TDF

Genvoya
EVG/c/FTC/TAF

Stribild
EVG/c/FTC/TDF

Odefsey
RPV/FTC/TAF

Complera
RPV/FTC/TDF

Descovy
FTC/TAF

Cimduo or Temixys
3TC/TDF

Truvada
FTC/TDF

Footnote

1    Lamivudine (3TC) may substitute for emtricitabine (FTC) or vice versa.

NOTES:

  • Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are two forms of tenofovir that are approved by the Food and Drug Administration. TAF has fewer bone and kidney toxicities than TDF, while TDF is associated with lower lipid levels. Safety, cost, and access are among the factors to consider when choosing between the two.
  • raltegravir (RAL) can be given as RAL 400 mg twice daily or RAL 1200 mg (two 600 mg tablets) once daily.