INSTI-based initial therapy in adults

In adults, an integrase strand transfer inhibitor (INSTI)–based regimen is preferred for initial antiretroviral therapy in most situations.

For initial antiretroviral therapy in adults with HIV antiviral resistance, seek expert advice.

For INSTI-based initial antiretroviral therapy in adults with hepatitis B virus co-infection, see Initial therapy for adults with HIV and hepatitis B virus co-infection.

Single-tablet, once-daily INSTI-based regimens are included below for adults with:

• an HIV viral load less than 500 000 RNA copies/mL
• an HIV viral load more than 500 000 RNA copies/mL.

If the single-tablet, once-daily INSTI-based regimens are not suitable, two-tablet, once-daily INSTI-based regimens may be considered.

If therapy with an INSTI-based regimen is not suitable, other effective combinations for initial therapy include:

• 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) plus a boosted protease inhibitor (PI)
• 2 NRTIs plus a non-nucleoside reverse transcriptase inhibitor (NNRTI).