Preferred HAART Regimens to Use for Initial HIV Treatment
Researchers are always looking at which regimens work best, have the fewest side effects, last longest, and are easiest to use. At the end of 2009, the Department of Health and Human Services (DHHS) published preferred initial treatment regimens, based on findings from studies.
With the new department’s recommendations, the previous "backbone" or "anchor drugs" for the NRTI component of triple regimens has changed. Abacavir ( Ziagen) and lamivudine ( Epivir, 3TC) were bumped down. This is partly due to a link between recent abacavir use and increased heart attack risk. With higher viral loads, it was also found to be less effective than the drugs tenofovir ( Viread) and emtricitabine ( Emtriva). According to Gandhi, this change has stirred some controversy because of concerns about tenofovir's potential impact on kidneys and bones. Lamivudine can cause serious liver damage and lactic acid buildup in the bloodstream.
Because of the variety of improved options, it’s no longer advised to take breaks from a treatment that causes severe side effects ("drug holidays" or intermittent therapy). "This is associated with increased mortality from all causes, not just from HIV," Ghandi says. Instead, people can now switch to a different regimen.
Alternative regimens can also be effective and well tolerated by some patients. But they can have disadvantages when compared with preferred regimens.
The list of preferred HAART regimens will likely continue to change over time. But here are the current regimens for initial treatment preferred by the Department of Health and Human Services.
Preferred NNRTI-Based Regimen
Note: Complera is another 3-drug combination pill taken once daily. Complera is a combination of Truvada (which combines the nucleoside reverse transcriptase inhibitors Emtriva and Viread) and the non-nucleoside reverse transcriptase inhibitor Edurant.
Efavirenz has always been a preferred HIV medication due to its potency, effectiveness, and durability -- even when compared to PIs, Gandhi says. She adds that its impact on blood fats, such as cholesterol, is limited. Another advantage is that it can be taken with two other drugs in one-pill-a-day regimen. "But adherence must be essentially perfect," Gandhi tells WebMD. This means you must take it exactly as prescribed or you are more likely to become resistant to it.
Preferred PI-Based Regimens
- Atazanavir ( Reyataz) boosted with low-dose ritonavir + tenofovir (Viread) + emtricitabine (Emtriva). Tenovir and emtricitabine are also available as a combination pill ( Truvada) and the two are combined with elvitegravir to make up Stribild, a once-daily pill.
- Darunavir ( Prezista) boosted with low-dose ritonavir (once daily) + tenofovir + emtricitabine
If you are relatively careful about taking medication as directed, a protease-based regimen could last you a very long time. "These are very durable, potent regimens that have the ability to last patients their entire lives,” Ghandi says.