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Single-Tablet Treatment Regimen for HIV

Medically Reviewed by Jonathan E. Kaplan, MD on May 29, 2020

Until recently, treatment for HIV, or antiretroviral therapy (ART), involved taking a mix of pills throughout the day. This is known as a multi-tablet regimen (MTR). You might also have heard it called “the cocktail.”

Now, single-tablet treatment regimens, or STRs, are becoming popular. STRs, also known as fixed-dose combinations, mix several drugs into one tablet or capsule that you take once a day. You take an STR around the same time every day. You’ll need to take some STRs with food.

Do Single Pills Work?

Though all medicines can have side effects, STRs and MTRs are safe and work well. There’s no cure for HIV or AIDS, but medication slows down virus growth. Most people who take the medication correctly can live a long, healthy life.

Single-pill regimens are helpful because they’re simple and convenient. It’s easier to remember to take one pill a day than several pills at different times of the day.

You may be more likely to stick to your treatment if you have a single-pill regimen. In one study, people who took one pill instead of a combination were almost twice as likely to stay on track with treatment.

This is important. Ongoing treatment, if you take it correctly, lowers the amount of HIV in your blood (you might hear this called your viral load) to a low or undetectable level. That’s how you stay healthy. It also prevents you from spreading it to your HIV-negative partners.

Skipping doses could lead to drug resistance. That means the virus gets used to the drug and it no longer works as well. This is why it is important to take your medicine as prescribed.

Who Should Take STRs?

A single-pill regimen may be the way to go if you want to simplify your meds. It can also be a good choice if you’re starting treatment for the first time.

One problem with STRs is that your doctor can’t change the doses of each individual drug. And switching to a single pill won’t work if you’re resistant to any of the drugs in it. This is why it’s important to discuss a change from an MTR to an STR regimen with your doctor. They can take into account all ART regimens you have taken in the past.

As with all ART regimens, you should discuss any problems you are having with your STR regimen before you make a change to your medication.

Types of STRs

New single-pill options are coming onto the market at a rapid pace. The first STR, a fixed-dose combination of three drugs in one tablet called Atripla, was introduced in 2006. Now, there are 11 single-regimen pills available. They are:

  • Atripla (efavirenz, emtricitabine, tenofovir disoproxil fumarate)
  • Biktarvy (bictegravir, emtricitabine, tenofovir alafenamide)
  • Complera (emtricitabine, rilpivirine, tenofovir disoproxil fumarate)
  • Odefsey (emtricitabine, rilpivirine, tenofovir alafenamide)
  • Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate)
  • Genvoya (elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide)
  • Triumeq (abacavir, dolutegravir, lamivudine)
  • Juluca (dolutegravir, rilpivirine)
  • Symtuza (darunavir, cobicistat, emtricitabine, tenofovir alafenamide)
  • Dovato (dolutegravir, lamivudine)
  • Delstrigo (doravirine, lamivudine, tenofovir disoproxil fumarate)

More pills will likely be available in the future.

Most combination therapies involve three or more drugs from different classes, including:

  • Integrase inhibitors that block HIV integrase, an enzyme that lets HIV make copies of itself
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs), which change an enzyme (called reverse transcriptase) that HIV needs to make copies of itself
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs), which also change reverse transcriptase
  • Protease inhibitors (PIs) that block protease, an enzyme HIV needs to make copies of itself

Many include a combination of two NRTIs plus a third drug from another group. This approach attacks and defeats the virus three different ways.

The FDA recently approved two new pills that have two drugs instead of three. This could be good for people with HIV because taking fewer drugs means less exposure to possible long-term effects. One is called Juluca. It’s only for people on maintenance, or ongoing, therapy. The other, called Dovato, is available for anyone starting treatment.

Costs of STRs

Single-dose pills may have a cost benefit. Taking fewer pills with fewer drugs could cost less than taking an assortment of pills. And having fewer prescriptions means having fewer copayments.

But some single-dose treatments are still expensive. That’s partly because generic versions of the drugs aren’t available yet.

WebMD Medical Reference

Sources

SOURCES:

U.S. Department of Veteran Affairs: “How is HIV Treated?” “HIV FAQ.”

U.S. Agency for International Development and US President’s Emergency Plan for AIDS Relief: “Tenofovir, Lamivudine, and Dolutegravir (TLD) Transition.”

Pharmacy and Therapeutics: “Once-Daily, Single-Tablet Regimens For the Treatment of HIV-1 Infection.”

Avert: “First two-drug pill approved for new HIV treatment starters.”

Federal Practitioner: “Single-Tablet Regimens in the Treatment of HIV-1 Infection.”

New York State Department of Health AIDS Institute: “Selecting an Initial ART Regimen.”

U.S. Department of Health & Human Services: “FDA-Approved HIV Medicines,” “HIV/AIDS Glossary,” “HIV Treatment Overview,” “Taking Your HIV Medication Every Day.”

News release, U.S. Department of Health & Human Services.

Mayo Clinic: “HIV/AIDS.”

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