skip navigation

Skip Nav

Education Materials

Skip Navigation

HIV Treatment

What to Start: Selecting a First HIV Regimen

(Last updated 11/7/2013; last reviewed 11/7/2013)

PrintHelp

Key Points

  • The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). ART involves taking 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 over 20 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 or more HIV medicines from at least two different drug classes.
  • The choice of HIV medicines to include in an HIV regimen varies depending on a person's individual needs. Factors to consider 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 involves taking a combination of HIV medicines (called an HIV regimen) every day.

There are over 20 HIV medicines approved for use in an HIV regimen. 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 treatment with a regimen of three or more 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 NNRTI, a PI, an INSTI, or a CCR5.

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 deciding on 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
  • Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in a single pill is convenient to follow.
  • Any personal issues that can make it difficult to follow an HIV regimen, for example, a busy schedule that changes from day to day

Careful consideration of these factors helps guide selection of an HIV regimen from the list of recommended regimens.

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

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

NNRTI-based regimen 

PI-based regimens

  • atazanavir (brand name: Reyataz) boosted with ritonavir (brand name: Norvir) plus Truvada 
  • Ritonavir is an HIV medicine given with other HIV medicines to increase (boost) their effectiveness. Truvada is a combination of two HIV medicines—emtricitabine and tenofovir disoproxil fumarate—in one pill.
  • darunavir (brand name: Prezista) boosted with ritonavir plus Truvada 

INSTI-based regimens 

  • dolutegravir (brand name: Tivicay) plus Truvada 
  • dolutegravir plus Epzicom for those who are HLA B*5701 negative. 
  • Epzicom is a combination of two HIV medicines—abacavir (brand name: Ziagen) and lamivudine (brand name: Epivir)—in one pill. 
  • raltegravir (brand name: Isentress) plus Truvada 
  • Stribild for those with estimated creatinine clearance (CrCl) ≥70 mL/min 
  • Stribild includes the following four medicines combined in one pill: elvitegravir, an HIV medicine only approved for use in Stribild; cobicistat, a medicine used to increase the effectiveness of elvitegravir; emtricitabine; and tenofovir disoproxil fumarate. 

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

How long does it take for treatment to work?

Viral load is the measure of HIV in a person’s blood. A main goal of HIV treatment 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 HIV treatment is effective.

Once a person starts treatment, 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 the undetectable viral load signals that HIV treatment is working effectively. Effective ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.