Key Principles and Recommended Regimens for First-line Antiretroviral Therapy

There are currently more than 30 individual ARV agents approved by the FDA for the treatment of HIV and more than 10 coformulated combination products. Among the numerous options available today, how can clinicians select the optimal treatment for an individual patient? This module will cover the basic principles behind regimen selection; it will then explore some commonly encountered patient scenarios that make particular regimens favored in certain settings.

The goals of initial therapy, as defined by the DHHS guidelines, include maximal and durable suppression of plasma HIV-1 RNA, restoration and preservation of immune function, reduction of HIV-associated morbidity, prolongation of the duration and quality of survival, and reduction of HIV transmission.^[1] This last goal is achieved when HIV-1 RNA is suppressed to below the lower limits of detection of currently available assays; today, those limits are HIV-1 RNA < 20-50 copies/mL. The established efficacy of HIV treatment-as-prevention is generally referred to as U = U, or undetectable = untransmittable.