| Coformulated abacavir, 600 mg/dolutegravir, 50 mg/lamivudine, 300 mg (Triumeq), once daily | Abacavir may increase risk of cardiotoxicity |
| Do not use if HLA-B*5701 positive |
| Do not use if creatinine clearance < 50 mL per minute per 1.73 m2 (0.83 mL per second per m2); dolutegravir inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting actual renal function |
| Multiple dolutegravir-associated drug interactions; overall lower risk of interactions than protease inhibitor– and cobicistat-containing regimens |
| Patients with hepatitis B or C virus coinfection may be at increased risk of transaminase elevation with dolutegravir use; risk of hepatitis flare in patients with hepatitis B when Triumeq is discontinued because lamivudine has anti–hepatitis B activity |
| Dolutegravir is relatively well tolerated and lipid- and glucose-neutral |
| Total daily pill count = 1; no food restrictions; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
| Coformulated elvitegravir, 150 mg/cobicistat, 150 mg/emtricitabine, 200 mg/tenofovir alafenamide, 10 mg (Genvoya), once daily | Lower risk of bone mineral loss and renal dysfunction with tenofovir alafenamide vs. tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels |
| Do not use if creatinine clearance < 30 mL per minute per 1.73 m2 (0.50 mL per second per m2); cobicistat inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting actual renal function; patients with > 0.4 mg per dL (35 μmol per L) increase in serum creatinine after treatment initiation should be monitored closely |
| Elvitegravir/cobicistat has potential for multiple drug interactions; other regimens may be preferred for patients receiving long-term therapy with medications that lead to increased risk of drug interactions |
| Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when Genvoya is discontinued; emtricitabine and tenofovir alafenamide also have anti–hepatitis B activity |
| Total daily pill count = 1; must be taken with food; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
| Coformulated elvitegravir, 150 mg/cobicistat, 150 mg/emtricitabine, 200 mg/tenofovir disoproxil fumarate, 300 mg (Stribild), once daily | Tenofovir disoproxil fumarate use increases risk of nephrotoxicity and decreased bone mineral density; consider alternative (e.g., tenofovir alafenamide) in patients with or at risk of renal disease or osteopenia/osteoporosis; use with caution in patients who recently took or are taking nephrotoxic agents (e.g., nonsteroidal anti-inflammatory drugs) |
| Do not initiate if creatinine clearance < 70 mL per minute per 1.73 m2 (1.17 mL per second per m2); discontinue if creatinine clearance < 50 mL per minute per 1.73 m2; cobicistat inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting actual renal function; patients with > 0.4 mg per dL increase in serum creatinine after treatment initiation should be monitored closely |
| Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when Stribild is discontinued |
| Elvitegravir/cobicistat has potential for multiple drug interactions; other regimens may be preferred for patients receiving long-term therapy with medications that lead to increased risk of drug interactions |
| Total daily pill count = 1; must be taken with food; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
| Darunavir, 800 mg (Prezista), once daily | Darunavir can cause rash (rarely, Stevens-Johnson syndrome), diarrhea, hepatotoxicity, hyperlipidemia, hyperglycemia, and fat maldistribution; use with caution in patients with severe sulfa allergy |
| plus | Highest risk of drug interactions; other regimens may be preferred for patients with certain comorbidities (e.g., dyslipidemia, diabetes mellitus) and those receiving long-term therapy with medications that lead to increased risk of drug interactions |
| Ritonavir, 100 mg (Norvir), once daily | |
| plus either | Tenofovir disoproxil fumarate use increases risk of nephrotoxicity and decreased bone mineral density; consider alternative (e.g., tenofovir alafenamide) in patients with or at risk of renal disease or osteopenia/osteoporosis; use with caution in patients who recently took or are taking nephrotoxic agents (e.g., nonsteroidal anti-inflammatory drugs) |
| Coformulated emtricitabine, 200 mg/tenofovir disoproxil fumarate, 300 mg (Truvada), once daily | Truvada dosing should be adjusted or use should be reconsidered if creatinine clearance < 50 mL per minute per 1.73 m2; Truvada is not recommended if creatinine clearance < 30 mL per minute per 1.73 m2 |
| or | Do not use Descovy in patients with creatinine clearance < 30 mL per minute per 1.73 m2 or in those receiving hemodialysis |
| Coformulated emtricitabine, 200 mg/tenofovir alafenamide, 25 mg (Descovy), once daily | Lower risk of bone mineral loss and renal dysfunction with tenofovir alafenamide vs. tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels |
| Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when Truvada or Descovy is discontinued |
| Coformulated darunavir/cobicistat (Prezcobix) appears equivalent to ritonavir-boosted darunavir and can be administered once daily with food; Prezcobix should not be administered with tenofovir disoproxil fumarate–containing agents if creatinine clearance < 70 mL per minute per 1.73 m2 |
| Total daily pill count = 3; darunavir must be taken with food; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
| Dolutegravir, 50 mg (Tivicay), once daily | Tenofovir disoproxil fumarate use increases risk of nephrotoxicity and decreased bone mineral density; consider alternative (e.g., tenofovir alafenamide) in patients with or at risk of renal disease or osteopenia/osteoporosis; use with caution in patients who recently took or are taking nephrotoxic agents (e.g., nonsteroidal anti-inflammatory drugs) |
| plus either |
| Coformulated emtricitabine, 200 mg/tenofovir disoproxil fumarate, 300 mg (Truvada), once daily |
| Truvada dosing should be adjusted or use should be reconsidered if creatinine clearance < 50 mL per minute per 1.73 m2; Truvada is not recommended if creatinine clearance < 30 mL per minute per 1.73 m2 |
| Do not use Descovy in patients with creatinine clearance < 30 mL per minute per 1.73 m2 or in those receiving hemodialysis |
| or | Lower risk of bone mineral loss and renal dysfunction with tenofovir alafenamide vs. tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels |
| Coformulated emtricitabine, 200 mg/tenofovir alafenamide, 25 mg (Descovy), once daily |
| Dolutegravir inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting actual renal function |
| Multiple dolutegravir-associated drug interactions; overall lower risk of interactions than protease inhibitor– and cobicistat-containing regimens |
| Patients with hepatitis B or C virus coinfection may be at increased risk of transaminase elevation with dolutegravir use |
| Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when Truvada or Descovy is discontinued |
| Total daily pill count = 2; no food restrictions; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
| Raltegravir, 400 mg (Isentress), twice daily | Raltegravir use can increase creatinine phosphokinase levels and risk of muscle pain/weakness |
| Some raltegravir-associated drug interactions, but fewer than other integrase- and protease inhibitor– containing regimens |
| plus either | |
| Coformulated emtricitabine, 200 mg/tenofovir disoproxil fumarate, 300 mg (Truvada), once daily | Tenofovir disoproxil fumarate use increases risk of nephrotoxicity and decreased bone mineral density; consider alternative (e.g., tenofovir alafenamide) in patients with or at risk of renal disease or osteopenia/osteoporosis; use with caution in patients who recently took or are taking nephrotoxic agents (e.g., nonsteroidal anti-inflammatory drugs) |
| Truvada dosing should be adjusted or use should be reconsidered if creatinine clearance < 50 mL per minute per 1.73 m2; Truvada is not recommended if creatinine clearance < 30 mL per minute per 1.73 m2 |
| or |
| Coformulated emtricitabine, 200 mg/tenofovir alafenamide, 25 mg (Descovy), once daily | Lower risk of bone mineral loss and renal dysfunction with tenofovir alafenamide vs. tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels |
| Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when Truvada or Descovy is discontinued |
| Raltegravir is relatively well tolerated and lipid- and glucose-neutral |
| Total daily pill count = 3; no food restrictions; should not be taken with magnesium-, aluminum-, or calcium-containing antacids |
