Table 1.

Initial combination regimens for antiretroviral therapy (ART)‐naïve adult HIV‐positive persons. (A) Recommended regimens (one of the following to be selected)^{a , b}. (B) Alternative regimens (to be used when none of the preferred regimens are feasible or available, whatever the reason)

A
Regimen	Dosing	Caution	Food requirement
2 NRTIs + INSTI
ABC/3TC/DTGc , d	ABC/3TC/DTG 600/300/50 mg, 1 tablet qd	Al/Ca/Mg‐containing antacids or multivitamins should be taken well separated in time (minimum 2 h after or 6 h before)	None
TAF/FTCe or TDF/FTCe	TAF/FTC 25/200 mg, 1 tablet qd or TDF/FTC 300/200 mg, 1 tablet qd		None
+DTG	+DTG 50 mg, 1 tablet qd	DTG 50 mg bid with rifampicin
TAF/FTC/EVG/ce or TDF/FTC/EVG/ce , f	TAF/FTC/EVG/c 10/200/150/150 mg, 1 tablet qd or TDF/FTC/EVG/c 300/200/150/150 mg, 1 tablet qd	Al/Ca/Mg‐containing antacids or multivitamins should be taken well separated in time (minimum 2 h after or 6 h before)	With food
TAF/FTCe or TDF/FTCe	TAF/FTC 25/200 mg, 1 tablet qd or TDF/FTC 300/200 mg, 1 tablet qd	Co‐administration of antacids containing Al or Mg not recommended. RAL 400 or 800 mg bid with rifampicin	None
+RAL	+RAL 400 mg, 1 tablet bid
2 NRTIs + NNRTI
TAF/FTC/RPVe or TDF/FTC/RPVe	TAF/FTC/RPV 25/200/25 mg, 1 tablet qd or TDF/FTC/RPV 300/200/25 mg, 1 tablet qd	Only if CD4 count > 200 cells/μL and HIV‐VL < 100 000 copies/mL. PPI contraindicated; H2 antagonists to be taken 12 h before or 4 h after RPV	With food
2 NRTIs + PI/r or PI/c
TAF/FTCe or TDF/FTCe	TAF/FTC 10/200 mg, 1 tablet qd or TDF/FTC 300/200 mg, 1 tablet qd	Monitor in persons with a known sulfonamide allergy	With food
+DRV/cg or +DRV/rg	DRV/c 800/150 mg, 1 tablet qd or +DRV 800 mg, 1 tablet qd + RTV 100 mg, 1 tablet qd

B
Regimen	Dosing	Caution	Food requirement
2 NRTIs + INSTI
ABC/3TCc , d+RAL	ABC/3TC 600/300 mg, 1 tablet qd + RAL 400 mg, 1 tablet bid	Co‐administration of antacids containing Al or Mg not recommended. RAL 400 or 800 mg bid with rifampicin	None
2 NRTIs + NNRTI
ABC/3TCc , d + EFVh	ABC/3TC 600/300 mg, 1 tablet qd + EFV 600 mg, 1 tablet qd	Only if HIV‐VL < 100 000 copies/mL	At bed time or 2 h before dinner
TDF/FTC/EFVe , h	TDF/FTC/EFV 300/200/600 mg, 1 tablet qd
2 NRTIs + PI/r or PI/c
TAF/FTCe or TDF/FTCe	TAF/FTC 10/200 mg 1 tablet qd or TDF/FTC 300/200 mg, 1 tablet qd		With food
+ATV/ci , j or +ATV/ri , j	+ATV/c 300/150 mg, 1 tablet qd or +ATV 300 mg, 1 tablet qd + RTV 100 mg, 1 tablet qd
ABC/3TCc , d +ATV/ci , j or +ATV/ri , j	ABC/3TC 600/300 mg, 1 tablet qd +ATV/c 300/150 mg 1 tablet qd or +ATV 300 mg, 1 tablet qd + RTV 100 mg, 1 tablet qd	Only if HIV‐VL < 100 000 copies/mL	With food
ABC/3TCc , d +DRV/cg or +DRV/rg	ABC/3TC 600/300 mg, 1 tablet qd +DRV/c 800/150 mg, 1 tablet qd or +DRV 800 mg, 1 tablet qd + RTV 1 tablet 100 mg, 1 tablet qd	Monitor in persons with a known sulfonamide allergy	With food
Other combinations
RALd +DRV/cg or +DRV/rg	RAL 400 mg, 1 tablet bid +DRV/c 800/150 mg, 1 tablet qd or +DRV 800 mg, 1 tablet qd + RTV 100 mg, 1 tablet qd	Only if CD4 count > 200 cells/μL and HIV‐VL < 100 000 copies/mL. Co‐administration of antacids containing Al or Mg not recommended	With food

^aOnly drugs currently licensed for initiation of therapy by the EMA are taken into consideration (in alphabetical order).

^bGeneric HIV drugs are becoming more available and can be used as long as they replace the same drug and do not break recommended fixed dose combinations.

^cABC contraindicated if HLA‐B*5701 positive. Even if HLA‐B*5701 negative, counselling on HSR risk still mandatory. ABC should be used with caution in persons with a high CVD risk (> 20%).

^dUse this combination only if HBsAg‐negative.

^eIn certain countries TDF is labelled as 245 mg rather than 300 mg to reflect the concentration of the active metabolite (tenofovir disoproxil). When available, combinations containing TDF can be replaced by the same combinations containing TAF, TAF is used at 10 mg when co‐administered with drugs that inhibit P‐gp, and at 25 mg when co‐administered with drugs that do not inhibit P‐gp. The decision whether to use TDF or TAF depends on individual characteristics as well as availability. So far, there are only limited long‐term data on TAF. TAF*** should be considered as a first choice**** over TDF in individuals with: established or high risk of CKD; co‐medication with nephrotoxic drugs or prior TDF toxicity; osteoporosis/progressive osteopenia or risk factors; history of fragility fracture. ***There are limited data on use of TAF with eGFR < 30 mL/min; **** Expert opinion pending clinical data.

^fTDF/FTC/EVG/c use only if eGFR ≥ 70 mL/min. It is recommended that TDF/FTC/EVG/c is not initiated in persons with eGFR < 90 mL/min unless this is the preferred treatment.

^gA single study has shown increase in CVD risk with cumulative use of DRV [13].

^hEFV: not to be given if history of suicide attempts or mental illness; not active against HIV‐2 and HIV‐1 group O strains.

ⁱCo‐administration of PPI is contraindicated. If PPI co‐administration is judged unavoidable, consider an alternative regimen; if given, dose increase of ATV to 400 mg qd may be considered, close clinical monitoring is recommended and doses of PPI comparable to omeprazole 20 mg should not be exceeded and must be taken approximately 12 h prior to the ATV/r. H2 antagonists to be taken 12 h before or 4 h after ATV.

^jPotential renal toxicity with ATV/r and ATV/c.