Current HIV Guidelines Narrow Initial Regimen Choices

When the U.S. Department of Health and Human Services and the International AIDS Society–USA updated their treatment guidelines in late 2009, there were two major changes: a paradigm shift toward earlier HIV treatment (discussed elsewhere in this Year in Review) and a narrowing of choices for initial regimens. Instead of laying out a menu of antiretrovirals and encouraging clinicians to mix and match from the preferred options, the new guidelines list four preferred regimens for initial treatment:

• Tenofovir/FTC/efavirenz (Atripla)

• Tenofovir/FTC + ritonavir-boosted darunavir

• Tenofovir/FTC + ritonavir-boosted atazanavir

• Tenofovir/FTC + twice-daily raltegravir

The demotion of abacavir/3TC and lopinavir/ritonavir-based regimens in these guidelines i…