First combination

In the UK the preferred first combination is usually an NNRTI + two nukes: efavirenz + Truvada (tenofovir + FTC).

This is because efavirenz is one of the best drugs at bringing down viral load and it is 1 pill, once-daily. Even though side effects are not straight-forward, the risk of serious side effects is low.

Truvada is a combination of tenofovir + FTC. It is 1 pill taken once-daily.

These 3 drugs are also available in a single pill called Atripla.

This single-pill option should usually only be prescribed once you have successfully responded to the same drugs taken separately.

In Europe this is because tenofovir is recommended to be taken with a meal to increase drugs levels. Efavirenz can be taken with or without food, but not with a high fat meal (as this increases the risk of side effects).

In practice, once your viral load is undetectable, Atripla can be taken with or without food.

If you don’t want to use efavirenz because of the type of side affects it causes or because you want to become pregnant, then the current choice is to use a boosted PI.

An alternative to Truvada is Kivexa. This is a 1 pill once-daily combination of different two nukes: abacavir + 3TC.