The two nukes

Two nukes are still included in most ART combinations. These are once-daily drugs with a low risk of side effects.

UK guidelines recommend TDx or TAF over abacavir, unless the third drug is dolutegravir.

Abacavir is rarely used as several studies showed that dolutegravir/lamivudine is just as effective as dolutegravir/lamivudine/abacavir.

Sometimes the two nukes are in a separate single pill. Sometimes they are included in a single pill for the whole HIV combination.

Abacavir/lamivudine (Kivexa) and tenofovir/emtricitabine (Truvada) are already off-patent. Generic versions of these drugs are now used in the UK.

Tenofovir DF (TDx)

TDx is widely used except in people who already have kidney or bone problems. It also has a small impact on reducing weight compared to TAF.

Tenofovir AF (TAF)

TAF is similar to TDx. It doesn’t affect kidney and bone health, but can lead to a little more weight gain. However, it is more expensive than either abacavir or TDx, which are both available as generics. See: Generic HIV drugs in the UK.

Abacavir (ABC)

Abacavir is rarely used in 2024. Using abacavir involves having a blood test (called HLA B*5701) to rule out the small chance of a sensitivity reaction. Abacavir should not be used if you have a high risk of heart problems.

Lamivudine (3TC) and emtricitabine (FTC)

3TC and FTC are very similar drugs with few side effects. Either can be used, but they should not be taken together.