HIV Treatment Regimens CDC Guidelines, Adult/Adolescent 

Updated: Sep 06, 2017
  • Author: Jason F Okulicz, MD, FACP, FIDSA; more...
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HIV Treatment Guidelines per the Centers for Disease Control

The Centers for Disease Control (CDC) and other federal government agencies have issued several guidelines and recommendations about the prevention, screening, diagnosis, treatment, and management of HIV infection. [1] The CDC references the most current Department of Health and Human Services (DHHS) guidelines for the use of antiretroviral agents in HIV-1–infected adults and adolescents, [2, 3] summarized below.

Initial combination regimens for antiretroviral-naive patients with HIV infection

An initial antiretroviral regimen generally consists of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) in combination with a third active drug from one of the following classes: nonnucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor (PI; boosted with ritonavir or cobicistat), or integrase strand transfer inhibitor (INSTI).

Selection of a regimen should be individualized based on virologic efficacy, potential adverse effects, pill burden, dosing frequency, drug-drug interaction potential, the patient's resistance test results, comorbid conditions, and cost.

Recommended initial antiretroviral therapy (ART) regimen options for treatment-naive patients with HIV infection

Recommended ART regimens for treatment-naive patients with HIV infection are as follows (*lamivudine may be substituted for emtricitabine or vice versa, if a non–fixed-dose NRTI combination is desired):

INSTI-based regimens are as follows:

  • Dolutegravir/abacavir/lamivudine* (only for patients who are HLA-B*5701 negative)
  • Dolutegravir plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine
  • Elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine
  • Elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine
  • Raltegravir plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine

PI-based regimen: Darunavir/ritonavir plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine

Alternative initial ART regimen options

Alternative regimens are effective and tolerable, but have potential disadvantages when compared with the recommended regimens, have limitations for use in certain patient populations, or have less supporting data from randomized clinical trials. However, an alternative regimen may be the preferred regimen for some patients.

Alternative initial ART regimen options are as follows (*lamivudine may substituted for emtricitabine or vice versa, if a non-fixed dose NRTI combination is desired):

NNRTI plus 2 NRTIs regimens are as follows:

  • Efavirenz/tenofovir disoproxil fumarate/emtricitabine*
  • Efavirenz plus tenofovir alafenamide/emtricitabine
  • Rilpivirine/tenofovir disoproxil fumarate/emtricitabine* or rilpivirine/tenofovir alafenamide/emtricitabine (if HIV RNA <100,000 copies/mL and CD4 >200 cells/µL)

Boosted PI plus 2 NRTIs regimens are as follows:

  • (Atazanavir/cobicistat or atazanavir/ritonavir) plus either tenofovir disoproxil fumarate/emtricitabine*  or tenofovir alafenamide/emtricitabine
  • Darunavir/cobicistat or darunavir/ritonavir plus abacavir/lamivudine*—if HLA-B*5701 negative
  • Darunavir/cobicistat plus either tenofovir disoproxil fumarate/emtricitabine* or tenofovir alafenamide/emtricitabine