Table 1.
What to start: specific agents recommended as first-line treatment and differences between the guidelines are highlighted, showing the eventual convergence of first-line recommendations between the developing and developed world
| DHHS | EACS | WHO | |
|---|---|---|---|
| Year/month | Preferred combination | ART regimen | Recommended ART regimen |
| 1998/06 | AZT/3TC (fixed-dose combination), AZT/ddI, AZT/ddC, AZT/ddI, D4T/ddI, D4T/3TC + IDV, SQV, NFV, RTV or SQV/RTV | ||
| 1998/12 | As above + addition of EFV as the third agent | ||
| 1999 | As above with addition of ddI/3TC as NRTI combination | ||
| 2000 | As above but high-dose RTV removed as third agent and ddI/3TC removed as NRTI combination | ||
| 2001 | As above with addition of RTV-boosted PI regimens as third agents [IDV/r, SQV/r, LPV/r (fixed-dose combination PI)] | ||
| 2002 | AZT/3TC + EFV, PI/r, NFV or ABC+ | ||
| 2003/07 | 3TC + (d4T, AZT or TDF) + EFV or 3TC + (d4T or AZT) + LPV/r | ||
| 2003/11 | As above but addition of FTC as alternative to 3TC in combination with (d4T, AZT or TDF) + EFV | Weighed pros and cons of NNRTI based vs. PI based with triple NRTI (AZT-3TC-ABC+) regimens | AZT or d4T + 3TC + NVP or EFV |
| 2005 | As above with deletion of d4T from first-line treatment and addition of FTC as alternative to 3TC in combination with AZT, LPV/r | ||
| 2006 | AZT/3TC or TDF/FTC (both fixed-dose combination) + EFV, ATV/r, FPV/r or LPV/r | ||
| 2008/01 | ABC+/3TC or TDF/FTC (both once daily fixed-dose combination) + EFV, ATV/r, FPV/r or LPV/r | ||
| 2008/11 | TDF/FTC + EFV, ATV/r, FPV/r, LPV/r, DRV/r | ABC+/3TC or TDF/FTC + EFV or NVP or a PI/r (FPV/r, LPV/r, SQV/r) | |
| 2009 | TDF/FTC + EFV or ATV/r or DRV/r or RAL | AZT or TDF + 3TC or FTC + EFV or NVP | |
| 2012 | As above | ||
| 2013/02 | TDF/FTC + EFV or ATV/r or DRV/r or RAL | ABC+/3TC or TDF/FTC + EFV or RPV (VL <100 000 copies ml−1) or ATV/r or DRV/r or RAL | TDF + 3TC or FTC + EFV |
| 2013/10 | As above, added TDF/FTC/EVG/co (if creatinine clearance >70 ml min−1) and DTG plus TDF/FTC or ABC+/3TC as preferred regimens |
ABC is used only in HLA-B&57:01-negative individuals. Abbreviations are as follows: 3TC, lamivudine; ABC, abacavir; ART, antiretroviral therapy; ATV, atazanavir; AZT, zidovudine; co, cobicistat; d4T, stavudine; ddC, zalcitabine; ddI, didanosine; DHHS, Department of Health and Human Services; DRV, darunavir; DTG, dolutegravir; EACS, European AIDS Clinical Society; EFV, efavirenz; EVG, elvitegravir; FPV, fosamprenavir; FTC, emtricitabine; IDV, indinavir; LPV, lopinavir; NFV, nelfinavir; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; NVP, nevirapine; PI, protease inhibitor; r, boosting dose ritonavir 100–200 mg daily; RAL, raltegravir; RPV, rilpivirine; RTV, high-dose ritonavir; SQV, saquinavir; TDF, tenofovir; VL, HIV viral load; WHO, World Health Organization.