Regimen	Adverse effects and comments†
Bictegravir, 50 mg/emtricitabine, 200 mg/tenofovir alafenamide, 25 mg (Biktarvy), once daily	Bictegravir/emtricitabine/tenofovir alafenamide is one of the preferred options if initiating antiretroviral therapy before baseline resistance testing results are available Not recommended for patients with creatinine clearance < 30 mL per minute per 1.73 m2 Bictegravir inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting actual renal function Patients with hepatitis B virus coinfection may be at increased risk of hepatitis flare when this medication is discontinued Refer to drug interaction resources for dosing instructions if taken with polyvalent cations (e.g., antacids, supplements)
Abacavir, 600 mg/dolute-gravir, 50 mg/lamivudine, 300 mg (Triumeq), once daily	Do not use abacavir if HLA-B*5701 test is positive Not recommended for patients with creatinine clearance < 50 mL per minute per 1.73 m2 Dolutegravir inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting renal function Patients with hepatitis B or C coinfection are at increased risk of transaminase elevation with dolutegravir use; risk of hepatitis flare in patients with hepatitis B when this medication is discontinued Dolutegravir is relatively lipid- and glucose-neutral but has been linked to weight gain Refer to drug interaction resources for dosing instructions when taken with polyvalent cations (e.g., antacids, supplements)
Dolutegravir, 50 mg (Tivicay), once daily Plus, any of the following:  Emtricitabine, 200 mg/tenofovir disoproxilfumarate, 300 mg (Truvada), once daily or  Emtricitabine, 200 mg/tenofovir alafenamide, 25 mg (Descovy), once daily or  Lamivudine, 300 mg/tenofovir disoproxil fumarate, 300 mg (Cimduo), once daily	Dolutegravir-based regimens are among the preferred options if initiating antiretroviral therapy before baseline resistance testing results are available Dolutegravir inhibits secretion of creatinine and can lead to a slight increase in serum creatinine levels without affecting renal function Patients with hepatitis B or C virus coinfection may be at increased risk of transaminase elevation with dolutegravir use Dolutegravir is relatively lipid- and glucose-neutral but it has been linked to weight gain Refer to drug interaction resources for dosing instructions when taken with polyvalent cations (e.g., antacids, supplements) 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 are taking nephrotoxic agents Risk of hepatitis flare in patients with hepatitis B when emtricitabine/tenofovir disoproxil fumarate is discontinued (similar caution if emtricitabine/tenofovir alafenamide or lamivudine/tenofovir disoproxil fumarate is discontinued) Lower risk of renal dysfunction and bone mineral loss with tenofovir alafenamide than with tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels and weight gain Avoid emtricitabine/tenofovir disoproxil fumarate if creatinine clearance < 60 mL per minute per 1.73 m2 Emtricitabine/tenofovir alafenamide is not recommended in patients with creatinine clearance < 30 mL per minute per 1.73 m2 Lamivudine/tenofovir disoproxil fumarate is not recommended in patients with creatinine clearance < 50 mL per minute per 1.73 m2
Dolutegravir, 50 mg/lamivudine, 300 mg (Dovato), once daily	Do not use if initial HIV RNA > 500,000 copies per mL, hepatitis B virus coinfection, or before a review of resistance testing and hepatitis B screening results May be preferred by patients who wish to take fewer medications (i.e., two-drug vs. three-drug regimens) Not recommended in patients with creatinine clearance < 50 mL per minute per 1.73 m2 Dolutegravir inhibits secretion of creatinine and can lead to slight increase in serum creatinine levels without affecting renal function Patients with hepatitis B or C virus coinfection are at increased risk of transaminase elevation with dolutegravir use Dolutegravir is relatively lipid- and glucose-neutral but has been linked to weight gain Refer to drug interaction resources for dosing instructions when taken with polyvalent cations (e.g., antacids, supplements)
Raltegravir, 400 mg (Isentress), twice daily Plus, any of the following:  Emtricitabine, 200 mg/tenofovir disoproxil fumarate, 300 mg, once daily or  Emtricitabine, 200 mg/tenofovir alafenamide, 25 mg, once daily or  Lamivudine, 300 mg/tenofovir disoproxil fumarate, 300 mg, once daily	Raltegravir is relatively well tolerated and lipid- and glucose-neutral; has been associated with increased creatinine phosphokinase levels, myopathy, and rhabdomyolysis More experience in pregnancy compared with dolutegravir and bictegravir 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 are taking nephrotoxic agents Risk of hepatitis flare in patients with hepatitis B when disoproxil fumarate is discontinued Lower risk of renal dysfunction and bone mineral loss with tenofovir alafenamide than tenofovir disoproxil fumarate, but possibly less favorable effects on lipid levels and weight gain Avoid emtricitabine/tenofovir disoproxil fumarate if creatinine clearance < 60 mL per minute per 1.73 m2 Emtricitabine/tenofovir alafenamide is not recommended in patients with creatinine clearance < 30 mL per minute per 1.73 m2 Lamivudine/tenofovir disoproxil fumarate is not recommended in patients with creatinine clearance < 50 mL per minute per 1.73 m2