The invaluable guidelines on antiretroviral therapy (ART) of adolescents and adults produced by the CDC, NIH, and HIVMA were updated on April 8, 2015. The following is a summary of some of the significant changes to the previous guidelines in recommendations regarding the choice of an initial antiretroviral regimen in treatment-naïve patients.

The continued development of new antiretroviral agents has led to changes in recommendations for initial ART in treatment-naïve patients. They now include four distinct regimens based on an integrase strand transfer inhibitor together with one ritonavir-boosted protease inhibitor-based regimen; each recommendation is graded AI. The recommended regimens are:

  • Dolutegravir/abacavir/lamivudine (only if HLA-B*5701-negative;
  • Dolutegravir/tenofovir fumarate/emtricitabine;
  • Elvitegravir/cobicistat/tenofovir fumarate/emtricitabine (only if CrCl > 70 mL/min);
  • Raltegravir/tenofovir fumarate/emtricitabine;
  • Darunavir/ritonavir/tenofovir fumarate/emtricitabine.

The following previously recommended regimens are now listed only as alternatives, with each recommendation graded BI:

  • Efavirenz/tenofovir fumarate/emtricitabine;
  • Atazanavir/ritonavir/tenofovir fumarate/emtricitabine.

Both these regimens were “demoted” because of toxicity. In the case of the efavirenz-based regimen, this involves adverse central nervous system reactions, including possible increased suicidality.

The following three regimens that were previously listed as recommended for individuals with a baseline plasma RNA concentration < 100,000 copies/mL or > 200 CD4+ T cells per mm3 are now considered alternatives:

  • Atazanavir/ritonavir/abacavir/lamivudine;
  • Efavirenz/abacavir/lamivudine;
  • Rilpivirine/tenofovir fumarate/lamivudine.