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HIV Treatment

What to Start: Selecting a First HIV Regimen

(Last updated 4/29/2015; last reviewed 4/29/2015)

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Key Points

  • The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). People on ART take a combination of HIV medicines (called an HIV regimen) every day.
  • HIV medicines are grouped into six drug classes according to how they fight HIV. The six drug classes include more than 25 HIV medicines.
  • The U.S. Department of Health and Human Services (HHS) provides guidelines on the use of HIV medicines to treat HIV infection. The HHS guidelines recommend starting treatment with a regimen of three HIV medicines from at least two different drug classes.
  • The choice of HIV medicines to include in an HIV regimen depends on a person's individual needs. Factors considered when choosing an HIV regimen include possible side effects of HIV medicines, the potential for drug interactions, and the health of the person with HIV.

What is the next step after deciding to start HIV treatment?

The next step is choosing the HIV medicines to take. The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission. People on ART take a combination of HIV medicines (called an HIV regimen) every day.

There are more than 25 HIV medicines approved to treat HIV infection. Some HIV medicines are available in combination (in other words, two or more different HIV medicines combined in one pill).

The U.S. Department of Health and Human Services (HHS) guidelines on the use of HIV medicines recommend starting ART with a regimen of three HIV medicines from at least two different drug classes. 

What are the HIV drug classes?

HIV medicines are grouped into six drug classes according to how they fight HIV. The six drug classes are:

In general, a person’s first HIV regimen includes two NRTIs in combination with an INSTI, an NNRTI, or a PI boosted with cobicistat (brand name: Tybost) or ritonavir (brand name: Norvir). Cobicistat and ritonavir are given with some HIV medicines to increase (boost) their effectiveness.

Click here to see the AIDSinfo fact sheet that lists the FDA-approved HIV medicines by drug class.


What factors are considered when choosing an HIV regimen?

The choice of HIV medicines to include in an HIV regimen depends on a person’s individual needs. When choosing an HIV regimen, people with HIV and their health care providers consider the following factors:
  • Other diseases or conditions that the person with HIV may have  
  • Possible side effects of HIV medicines
  • Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking
  • Results of drug-resistance testing (and other tests). Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV.  
  • Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is convenient to follow.
  • Any issues that can make it difficult to follow an HIV regimen, such as a busy schedule that changes from day to day
  • Cost of HIV medicines

There are several recommended HIV regimens, but selecting the best regimen for a particular person depends on the factors listed above. 

What are the recommended regimens for people taking HIV medicines for the first time?

The HHS guidelines recommend the following regimens for people taking HIV medicines for the first time:  

INSTI-based regimens

  • dolutegravir (brand name: Tivicay) plus Truvada. Truvada is a combination of two HIV medicines—emtricitabine (brand name: Emtriva) and tenofovir disoproxil fumarate (brand name: Viread)—in one pill.
  • raltegravir (brand name: Isentress) plus Truvada
  • Stribild, which includes the following four medicines combined in one pill: elvitegravir (brand name: Vitekta), cobicistat, a medicine that increases the effectiveness of elvitegravir; emtricitabine; and tenofovir disoproxil fumarate. Stribild is recommended only for those with creatinine clearance (CrCl) >70 mL/min before starting ART. (CrCl measures how well the kidneys are working.)
  • Triumeq, which includes the following three HIV medicines combined in one pill: abacavir (brand name: Ziagen), dolutegravir, and lamivudine (brand name: Epivir). Because it contains abacavir, Triumeq is recommended only for those who are HLA-B*5701 negative. HLA-B*5701 is a gene variation that is linked to a serious allergic reaction to abacavir.

PI-based regimens

  • darunavir (brand name: Prezista) boosted with ritonavir plus Truvada
    Ritonavir increases (boosts) the effectiveness of darunavir.

Because the needs of people with HIV vary, the regimens recommended for the initial treatment of HIV may not be right for everyone. The HHS guidelines list alternative HIV regimens to use if none of the recommended regimens meet a person’s individual needs. An alternative regimen may actually be the preferred regimen for a person.

How long does it take for ART to work?

Viral load is the measure of HIV in a person’s blood. A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. An undetectable viral load is the best sign that ART is effective.

Once a person starts taking HIV medicines, it’s possible to have an undetectable viral load within 3 to 6 months. Having an undetectable viral load doesn’t mean a person’s HIV is cured. There is still some HIV in the person’s body, but an undetectable viral load is a sign that ART is working effectively. Effective ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

This fact sheet is based on information from the following sources:

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