Guides

First combination

Integrase based ART

As UK guidelines (from 2016) were still due to be updated when we printed this booklet, this section is based on the more recent EU and US guidelines (2019).

This page will be updated as soon as new UK guidelines are available (expected in 2020).

  • Most guidelines now recommend first ART that uses three drugs: an integrase inhibitor (INI) plus two nukes. 
  • More recently, the choice of a two-drug combination has also been approved: using the integrase inhibitor dolutegravir plus one nuke (lamivudine).

An integrase inhibitor is recommended (rather than an NNRTI or PI) because they reduce viral load more quickly and often have fewer side effects. 

With three-drug ART, the options for the two nukes are discussed here.

Some combinations include a booster drug (making four drugs overall). Boosting involves slowing down how your liver processes a drug. This makes drug levels of the boosted drug stay higher for longer.

The two drugs used as boosters are ritonavir and cobicistat; they can be given as separate pills or, for some treatments, combined with one or more other drugs in a single pill.

Alternatives: using a PI or NNRTI

NNRTI- or PI-based ART is still an alternative in some situations.

In these cases, guidelines recommend darunavir as the boosted PI and rilpivirine or doravirine as the NNRTI.

These drugs have limitations though. Both rilpivirine and darunavir need to be taken with food, darunavir needs to be boosted and rilpivirine can not be used if you start with a high viral load.

Doravirine is a more recently approved NNRTI that can be taken with or without food. 

HIV treatment is not rocket science. You can easily learn about it. I am sure I get better treatment for my HIV because I understand what is going on. This gives me the confidence that I should live a long and happy life.

I talk with my doctor and I take an active role in my choice of treatment. I always say if I have problems with side effects or adherence.

– Paul, London

Last updated: 1 October 2019.