Table 1.
Recommended and alternative initial antiretroviral regimens, including strength of recommendations and quality of evidence
| Recommended regimens | Alternative regimens | Comments | |
|---|---|---|---|
| NNRTI plus | Efavirenz/tenofovir/emtricitabine (AI). | Nevirapine plus tenofovir/emtricitabine or abacavir/lamivudine (BI). | Severe hepatotoxicity and rash with nevirapine are more common in initial therapy when CD4 cell count is >250/μL in women and >400/μL in men. |
| NRTIs | Efavirenz plus abacavir/lamivudine (AI) in HLA-B 5701-negative patients with baseline plasma HIV-RNA <100,000 copies/mL. | ||
| PI/r plus | Darunavir/r plus tenofovir/emtricitabine (AI). | Darunavir/r plus abacavir/lamivudine (BIII). | Other alternative PIs include fosamprenavir/r and saquinavir/r, but indications to use these options for initial treatment are rare. |
| NRTIs | Atazanavir/r plus tenofovir/emtricitabine (AI). | ||
| Atazanavir/r plus abacavir/lamivudine (AI) in patients with plasma HIV-RNA <100,000 copies/mL. | Lopinavir/r plus tenofovir/emtricitabine (BI) (or abacavir/lamivudine) (BI). | ||
| InSTI plus NRTIs | Raltegravir plus tenofovir/emtricitabine (AI). | Raltegravir plus abacavir/lamivudine (BII). | Raltegravir is given twice daily. |
Notes: Fixed-dose combinations are recommended when available and appropriate. Current fixed-dose combinations available are: efavirenz/tenofovir/emtricitabine; tenofovir/emtricitabine; abacavir/lamivudine; lopinavir/ritonavir.
Abbreviations: InSTI, integrase strand transfer inhibitor; NNRTI, nonnucleoside reverse-transcriptase inhibitor; NRTI, nucleos(t)ide reverse-transcriptase inhibitor; PI, protease inhibitor; /r, ritonavir-boosted ; AI, strong support for the recommendation - evidence from one or more randomized controlled clinical trials; BI, moderate support for the recommendation - evidence from one or more randomized controlled clinical trials; BII, moderate support for the recommendation - evidence from nonrandomized clinical trials or cohort or case control studies; BIII, moderate support for the recommendation - recommendation based on the panel’s analysis of the accumulated available evidence; RNA, ribonucleic acid.