Synopsis
Select and monitor complete combination antiretroviral therapy, prevent interaction and resistance failure, preserve hepatitis B treatment and respond systematically to detectable viral load.
- ART uses a complete combination that blocks at least two viral replication targets; never prescribe HIV monotherapy.
- An integrase inhibitor with two nucleoside or nucleotide agents is a common initial strategy, but resistance, hepatitis B, pregnancy, renal function and interactions determine the exact regimen.
- Take a baseline resistance genotype and viral load, but rapid treatment usually begins before every result returns and is modified if necessary.
Key red flags
Never rechallenge abacavir after suspected hypersensitivity because recurrence can be rapidly fatal.
Fever, rash, gastrointestinal or respiratory symptoms after abacavir or systemic mucosal disease with another agent needs urgent cessation planning.
Investigation priorities
Quantify response after initiation or switch and detect loss of suppression.
Management branches
ART is starting or a planned switch is being considered.
- Review resistance, viral load, CD4, hepatitis B, HLA-B*57:01, kidney, liver, pregnancy, tuberculosis and previous ART.
- Choose an approved complete regimen with at least two fully active components and a high resistance barrier when uncertainty exists.
Key medicines
Bictegravir, emtricitabine and tenofovir alafenamideGive one tablet containing 50 mg/200 mg/25 mg orally once daily when selected as a complete regimen.
Dolutegravir plus tenofovir disoproxil and emtricitabineGive dolutegravir 50 mg orally once daily plus tenofovir disoproxil 245 mg and emtricitabine 200 mg orally once daily when specialist-selected.