Table 3:
Two-drug regimens recommended for treatment of HIV-1 infection
| DHHS guidelines43 | EACS guidelines44 | WHO guidelines45 | IAS guidelines46 | |
|---|---|---|---|---|
|
| ||||
| Recommendations for initial treatment in antiretroviral therapy-naive individuals | ||||
| Recommended regimens | Dolutegravir plus lamivudine (A1); ritonavir-boosted darunavir plus lamivudine (C1); ritonavir-boosted darunavir plus raltegravir (C1) | Dolutegravir plus lamivudine | Not mentioned | Dolutegravir plus lamivudine (A1a) |
| Exclusions for dolutegravir plus lamivudine | Viral load >500 000 copies per mL; HBV co-infection; before results of HIV genotypic resistance or HBV testing | Viral load >500 000 copies per mL; HBV co-infection; PREP failure | NA | Viral load >500 000 copies per mL; HBV co-infection; before results of HIV genotypic resistance or HBV testing; CD4 cell count <200 cells per μL |
| Exclusions for ritonavir-boosted darunavir plus lamivudine | HBV co-infection; before results of HIV genotypic resistance or HBV testing | NA | NA | NA |
| Exclusions for ritonavir-boosted darunavir plus raltegravir | Viral load >100 000 copies per mL; CD4 cell count <200 cells per μL; HBV co-infection; before results of HIV genotypic resistance or HBV testing | NA | NA | NA |
| Recommendations for antiretroviral therapy switch in virologically suppressed individuals | ||||
| Recommended regimens | Dolutegravir plus rilpivirine (A1); dolutegravir plus lamivudine (A1); boosted protease inhibitor plus lamivudine (B1–C1); dolutegravir plus boosted darunavir (C1); long-acting cabotegravir plus rilpivirine (A1) | Dolutegravir plus rilpivirine; dolutegravir plus lamivudine; boosted darunavir plus lamivudine; boosted atazanavir plus lamivudine; boosted darunavir plus rilpivirine;* long-acting cabotegravir plus rilpivirine | Not mentioned | Dolutegravir plus lamivudine (A1a); dolutegravir plus rilpivirine (A1a); ritonavir-boosted darunavir plus lamivudine (A1a); long-acting cabotegravir plus rilpivirine administered every 4 weeks (A1a); long-acting cabotegravir plus rilpivirine administered every 8 weeks (B1b);39,40† |
| Exclusions and limitations of recommendations | HBV co-infection | Reported only as potential options; no historical resistance; absence of chronic HBV co-infection | NA | HBV co-infection |
A1=strong data from randomised controlled trials. A1a=strong panel support from ≥1 randomised controlled trials published in peer-reviewed literature. B1=moderate data from randomised controlled trials. B1b=moderate panel support from ≥1 randomised controlled trials presented in abstract form at peer-reviewed scientific meetings. C1=optional data from randomised controlled trials. DHHS=United States Department of Health and Human Services. EACS=European AIDS Clinical Society. HBV=hepatitis B virus. IAS=International Antiviral Society. NA=not applicable. PREP=pre-exposure prophylaxis.
Use recommended only by small trials.
This rating for long-acting cabotegravir plus rilpivirine administered every 8 weeks could be due to the publication of guidelines before results of the ATLAS-2M trial, which have since become available.
DHHS guidelines were last updated in August, 2021. EACS guidelines were last updated in October, 2021. IAS guidelines were last updated in October, 2020. WHO guidelines were last updated in July, 2021. IAS guidelines do not recommend dolutegravir plus lamivudine for patients with chronic hepatitis B or HIV RNA level above 500 000 copies per mL (and potentially a CD4 cell count below 200 per μL, although this is unclear). IAS guidelines recommend monitoring patients for adherence and virological response. Dolutegravir plus lamivudine is not recommended for patients who are being treated for an active opportunistic infection,such as tuberculosis, toxoplasmosis, and pneumocystis.