TABLE 12.

Alternative initial antiretroviral therapy regimens for previously untreated patients.

Regimen	Notes
TDF + 3TC (or FTC) + EFV	EFV can be used at 600 mg nocte or 400 mg nocte. EFV 400 mg dose is associated with fewer side effects and less LTFU.22 EFV 400 mg dose is not available in FDC in South Africa. There are insufficient data to recommend the EFV 400 mg dose in patients who are pregnant and patients receiving RIF although small-cohort studies have suggested that adequate concentrations are achieved in these patients.65,66
TDF + 3TC (or FTC) + RPV	RPV cannot be used in patients receiving RIF. RPV should not be used in initial therapy when baseline VL is > 100 000 copies/mL.
ABC + 3TC + DTG	International guidelines recommend HLA-B*5701 testing before prescribing ABC because a negative result rules out the risk of hypersensitivity reaction. However, this genotype is very rare in people of African descent and is thus probably not indicated. In patients of non-African descent, HLA-B*5701 testing should be considered if ABC is to be used, although access to this test is limited in South Africa.

3TC, lamivudine; ABC, abacavir; DTG, dolutegravir; EFV, efavirenz; FTC, emtricitabine; LTFU, loss to follow-up; RIF, rifampicin; RPV, rilpivirine; TDF, tenofovir; VL, viral load; FDC, fixed-dose combination.