{"id":1924,"date":"2024-11-01T12:00:36","date_gmt":"2024-11-01T12:00:36","guid":{"rendered":"http:\/\/moomango.co.uk\/guides\/?page_id=1924"},"modified":"2025-01-20T15:16:11","modified_gmt":"2025-01-20T15:16:11","slug":"first-combination","status":"publish","type":"page","link":"https:\/\/i-base.info\/guides\/starting\/first-combination","title":{"rendered":"First ART &#8211; recommended drug combinations"},"content":{"rendered":"<p><strong>This information is based on UK guidelines (2023 update). <\/strong><\/p>\n<p>This will be updated if the guidelines change.<\/p>\n<p>The UK currently recommends choosing one of the following once-daily options:<\/p>\n<ol>\n<li>Bictegravir\/emtricitabine\/TAF (1 small pill) <strong>(Biktarvy)<\/strong><\/li>\n<li><span style=\"font-variant-caps: normal;\">Dolutegravir + emtricitabine\/TAF or <\/span><span style=\"font-variant-caps: normal;\">emtricitabine\/TDX (2 pills)\u00a0<\/span><\/li>\n<li><span style=\"font-variant-caps: normal;\">Dolutegravir\/lamivudine (1 medium pill) <strong>(Dovato)<\/strong><\/span><\/li>\n<li>Dolutegravir\/lamivudine\/abacavir (one large pill) <strong>(Triumeq)<\/strong><\/li>\n<\/ol>\n<h2>Integrase inhibitor based ART<\/h2>\n<p><strong>All guidelines now recommend first-time ART that uses an integrase inhibitor (INSTI).<\/strong><\/p>\n<p>This is recommended in the UK, US, Europe, and by the World Health Organisation.<\/p>\n<ul>\n<li>This choice of INSTI is either <a href=\"https:\/\/i-base.info\/guides\/8851\">dolutegravir<\/a> or <a href=\"https:\/\/i-base.info\/guides\/13754\">bictegravir<\/a> (in <a href=\"https:\/\/i-base.info\/guides\/13752\">Biktarvy<\/a>).<\/li>\n<li>The combination usually also needs to include two nukes. <a href=\"https:\/\/i-base.info\/guides\/starting\/the-two-nukes\">Options for the two nukes<\/a>.<\/li>\n<li>Dolutegravir can sometimes be used in a two-drug ART with one nuke (lamivudine, 3TC). The brandname for this option is <a href=\"https:\/\/i-base.info\/guides\/14379\">Dovato<\/a>.<\/li>\n<\/ul>\n<p>These two integrase inhibitors have less risk of resistance and generally have fewer side effects than earlier INSTIs.<\/p>\n<h2>Alternatives<\/h2>\n<p>NNRTI- or PI-based ART is still an alternative if an INSTI can\u2019t be used.<\/p>\n<p>In these cases, guidelines recommend <a href=\"https:\/\/i-base.info\/guides\/3555\">darunavir<\/a> as the PI and <a href=\"https:\/\/i-base.info\/guides\/14411\">doravirine<\/a> as the NNRTI.<\/p>\n<ul>\n<li>Darunavir needs to be taken with food and a booster drug.<\/li>\n<li>Doravirine can be taken with or without food.<\/li>\n<li>The INSTI <a href=\"https:\/\/i-base.info\/guides\/3567\">raltegravir<\/a> can also be used if doultegravir or bictegravir are difficult to tolerate.<\/li>\n<\/ul>\n<h2>Booster drugs<\/h2>\n<p>Some combinations include a booster drug (making four drugs overall).<\/p>\n<p>Boosting involves slowing down how your liver processes a drug. This makes the boosted drug stay in your body at higher levels for longer.<\/p>\n<ul>\n<li>The two drugs used as boosters are <a href=\"https:\/\/i-base.info\/guides\/3557\">ritonavir<\/a> and <a href=\"https:\/\/i-base.info\/guides\/8930\">cobicistat<\/a><\/li>\n<li>They can be given as separate pills or, for some treatments, combined with one or more other drugs in a single pill.<\/li>\n<\/ul>\n<h2>Viral load after starting ART<\/h2>\n<p><strong>In the UK, viral load should be checked after the first month on ART. <\/strong><\/p>\n<p><strong>Whatever combination you start with, viral load should become undetectable within 1 to 3 months.<\/strong><\/p>\n<p>Sometimes this might take longer if viral load started off very high \u2013 for example over 1 million copies\/mL. <a href=\"https:\/\/i-base.info\/htb\/35801\">This report<\/a> explains examples of viral load sometimes taking longer to become undetectable.<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-15878\" src=\"https:\/\/i-base.info\/guides\/wp-content\/uploads\/2022\/08\/tabs.png\" alt=\"\" width=\"514\" height=\"137\" srcset=\"https:\/\/i-base.info\/guides\/wp-content\/uploads\/2022\/08\/tabs.png 514w, https:\/\/i-base.info\/guides\/wp-content\/uploads\/2022\/08\/tabs-300x80.png 300w\" sizes=\"auto, (max-width: 514px) 100vw, 514px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This information is based on UK guidelines (2023 update). This will be updated if the guidelines change. The UK currently recommends choosing one of the following once-daily options: Bictegravir\/emtricitabine\/TAF (1 small pill) (Biktarvy) Dolutegravir + emtricitabine\/TAF or emtricitabine\/TDX (2 pills)\u00a0 &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1547,"menu_order":47,"comment_status":"closed","ping_status":"closed","template":"page-guides.php","meta":{"footnotes":""},"class_list":["post-1924","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/1924","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/comments?post=1924"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/1924\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/1547"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/media?parent=1924"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}