Table 1: Preferred and Alternative Regimens for Rapid ART Initiation in Nonpregnant Adults
Regimen Comments Rating
Preferred Regimens for Patients Not on PrEP
Tenofovir alafenamide/ emtricitabine/bictegravir(TAF 25 mg/FTC/BIC; Biktarvy)
  • TAF/FTC/BIC is available as a single-tablet formulation, taken once daily.
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • This regimen contains 25 mg of TAF, unboosted.
  • Magnesium- or aluminum-containing antacids may be taken 2 hours before or 6 hours after BIC; calcium-containing antacids or iron supplements may be taken simultaneously if taken with food.
A1
Tenofovir alafenamide/ emtricitabine and dolutegravir [a](TAF 25 mg/FTC and DTG; Descovy and Tivicay)
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • This regimen contains 25 mg of TAF, unboosted.
  • Administer as 2 tablets once daily.
  • Magnesium- or aluminum-containing antacids may be taken 2 hours before or 6 hours after DTG; calcium-containing antacids or iron supplements may be taken simultaneously if taken with food.
  • Documented DTG resistance after initiation in treatment-naive patients is rare.
A1
Tenofovir alafenamide/ emtricitabine/darunavir/ cobicistat(TAF 10 mg/FTC/DRV/COBI; Symtuza)
  • TAF/FTC/DRV/COBI is available as a single-tablet formulation, taken once daily.
  • This regimen contains 10 mg TAF, boosted.
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • Pay attention to drug-drug interactions.
A2
Regimen for Patients Who Have Taken TDF/FTC as PrEP Since Their Last Negative HIV Test [b]
Tenofovir alafenamide/ emtricitabine and dolutegravir [a](TAF 25 mg/FTC and DTG; Descovy and Tivicay)
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • Documented DTG resistance after initiation in treatment-naive patients is rare.
  • Magnesium- or aluminum-containing antacids may be taken 2 hours before or 6 hours after DTG; calcium-containing antacids or iron supplements may be taken simultaneously if taken with food.
  • TDF may be substituted for TAF; TDF/FTC is available as a single tablet (brand name Truvada).
  • 3TC may be substituted for FTC; 3TC/TDF is available as a single tablet (brand name Cimduo).
A1
Tenofovir alafenamide/ emtricitabine/bictegravir(TAF 25 mg/FTC/BIC; Biktarvy)
  • TAF/FTC/BIC is available as a single-tablet formulation, taken once daily.
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • This regimen contains 25 mg of TAF, unboosted.
  • Magnesium- or aluminum-containing antacids may be taken 2 hours before or 6 hours after BIC; calcium-containing antacids or iron supplements may be taken simultaneously if taken with food.
A1
Tenofovir alafenamide/ emtricitabine/darunavir/ cobicistat(TAF 10 mg/FTC/DRV/COBI; Symtuza)
  • TAF/FTC/DRV/COBI is available as a single-tablet formulation, taken once daily.
  • This regimen contains 10 mg TAF, boosted.
  • TAF/FTC should not be used in patients with CrCl <30mL/min; re-evaluate after baseline laboratory testing results are available.
  • Pay attention to drug-drug interactions.
B2
Regimen for Patients Who Have Taken CAB LA as PrEP Within the Previous 14 Months
Tenofovir alafenamide/ emtricitabine/darunavir/ cobicistat(TAF 10 mg/FTC/DRV/COBI; Symtuza)
  • TAF/FTC/DRV/COBI is available as a single-tablet formulation, taken once daily.
  • This regimen contains 10 mg TAF, boosted.
  • TAF/FTC should not be used in patients with CrCl <30 mL/min; re-evaluate after baseline laboratory testing results are available.
  • Pay attention to drug-drug interactions.
A2
Medications to Avoid
  • Abacavir (ABC)
  • Rilpivirine (RPV)
  • Efavirenz (EFV)
  • Dolutegravir/lamivudine (DTG/3TC)
  • ABC should be avoided unless a patient is confirmed to be HLA-B*5701 negative.
  • RPV should be administered only in patients with a confirmed CD4 count ≥200 cells/mm3 and an HIV RNA level <100,000 copies/mL.
  • EFV is not as well tolerated as other ARVs, and NNRTIs have higher rates of resistance than other classes.
  • DTG/3TC requires baseline resistance testing and is not recommended when HBV status is unknown.
A3

Abbreviations: 3TC, lamivudine; ABC, abacavir; ART, antiretroviral therapy; ARV, antiretroviral medication; BIC, bictegravir; CAB LA, long-acting injectable cabotegravir; COBI, cobicistat; CrCl, creatinine clearance; DRV, darunavir; DTG, dolutegravir; EFV, efavirenz; FTC, emtricitabine; HBV, hepatitis B virus; NNRTI, non-nucleoside reverse transcriptase inhibitor; PrEP, pre-exposure prophylaxis; RPV, rilpivirine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.

Notes:

a
b

The initial ART regimen may be simplified based on results of genotypic resistance testing.

From: Rapid ART Initiation

Cover of Rapid ART Initiation
Rapid ART Initiation [Internet].
Radix AE, Fine SM, Vail RM, et al.
Baltimore (MD): Johns Hopkins University; 2023 Feb.
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