What is HIV infection?

Human immunodeficiency virus (HIV) infection is caused by a virus that attacks the T-cells of the human immune system. This results in progressive weakening of the immune system leading to acquired immune deficiency syndrome (AIDS), when the body is no longer able to fight infection effectively. HIV has no cure and can only be controlled by lifelong medication.

What is antiretroviral therapy (ART) for HIV infection?

Antiretroviral therapy (ART) is a treatment regimen for HIV infection with a combination of three or more classes of drugs. Each drug class attacks the virus in a different way at different phases of its replication cycle. ART controls the viral growth and minimizes the chances of transmission of HIV infection.

What are the drug combinations for ART?

ART is usually tailored to suit individual requirements. Currently, seven classes of drugs are available individually, but can be combined for a complete ART regimen.

  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Integrase inhibitors (INSTIs)
  • Fusion inhibitors (FIs)
  • Chemokine receptor antagonists (CCR5 antagonists)
  • Post-attachment entry inhibitors

The combination of a complete regimen typically consists of two NRTIs and one or more of the other drug classes, depending on the patient’s condition and stage of infection.

The ART drugs are also available in a single tablet form for people who find it difficult to take multiple pills. These single tablets are a complete regimen with a combination of three or four classes of drugs, each in a fixed dose.

Most of the fixed as well as individualized combination regimens also include a boosting drug (pharmacokinetic enhancer) which enhance the performance of ART drugs by delaying their breakdown and making them remain for a longer duration in the body. The boosting drug that is currently in use is cobicistat (Tybost).

What are the single tablet ART regimens for HIV infection?

Following is a list of single tablet fixed dose, complete ART regimens taken once a day:

Stribild

  • Elvitegravir (150 mg) - (INSTI)
  • Cobicistat (150 mg) - (Booster)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NRTI)

Genvoya

  • Elvitegravir (150 mg) - (INSTI)
  • Cobicistat (150 mg) - (Booster)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir AF (10 mg) - (NRTI)

Symtuza

  • Darunavir (800 mg) - (PI)
  • Cobicistat (150 mg) - (Booster)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir AF (10 mg) - (NRTI)

Odefsey

  • Rilpivirine (25 mg) - (NNRTI)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir AF (25 mg) - (NRTI)

Complera

  • Rilpivirine (25 mg) - (NNRTI)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NRTI)

Biktarvy

  • Bictegravir (50 mg) - (INSTI)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir AF (25 mg) - (NRTI)

Triumeq

Juluca

A complete regimen only for adults who have well-controlled infection, on a stable ART regimen for 6 months or more, with no history of drug resistance.

  • Dolutegravir (50 mg) - (INSTI)
  • Rilpivirine (25 mg) - (NNRTI)

Dovato

A complete regimen only for treatment-naïve adults with no known resistance to dolutegravir or lamivudine

  • Dolutegravir (50 mg) - (INSTI)
  • Lamivudine (300 mg) - (NRTI)

Atripla

May be used alone as a complete regimen or in combination with other ARTs.

  • Efavirenz (600 mg) - (NNRTI)
  • Emtricitabine (200 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NRTI)

Symfi

  • Efavirenz (600 mg) - (NNRTI)
  • Lamivudine (300 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NRTI)

Symfi Lo

  • Efavirenz (400 mg) - (NNRTI)
  • Lamivudine (300 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NRTI)

Delstrigo

  • Doravirine (100 mg) - (NNRTI)
  • Lamivudine (300 mg) - (NRTI)
  • Tenofovir DF (300 mg) - (NNRTI)

NRTI combinations

Nucleoside reverse transcriptase inhibitors form the backbone of ART combination. Following are the currently available fixed NRTI combinations that can be taken once a day, along with more drug classes as needed:

Descovy

  • Emtricitabine (200 mg)
  • tenofovir AF (25 mg)

Truvada

  • Emtricitabine (200 mg)
  • Tenofovir DF (300 mg)

Epzicom

  • Abacavir (600 mg)
  • Lamivudine (300 mg)

Cimduo

  • Lamivudine (300 mg)
  • Tenofovir DF (300 mg)

NRTI combinations taken twice a day

Trizivir

  • Abacavir (300 mg)
  • Lamivudine (150 mg)
  • Zidovudine (300 mg)

Combivir

  • Zidovudine (300 mg)
  • Lamivudine (150 mg)

Protease inhibitor combinations

Two protease inhibitor combinations with the booster drug cobicistat that can be taken as a single pill along with NRTIs:

Evotaz

Prezcobix

  • Darunavir ethanolate (800 mg)
  • Cobicistat (150 mg)

SLIDESHOW

A Timeline of the HIV/AIDS Pandemic See Slideshow

Summary

Antiretroviral Therapy (ART) for HIV is usually tailored to suit individual requirements. Currently, seven classes of drugs are available individually, but can be combined for a complete ART regimen, which usually contains three different drugs targeting the virus at different stages of replication. ART regimens are increasingly combined in single-tablet formulations to help patients comply with treatment and avoid the disease progressing into AIDS (acquired immunodeficiency syndrome).

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Medically Reviewed on 7/10/2020
References
Medscape Medical Reference
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