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Recommended first HIV treatment combination

In the UK, if you are starting HIV treatment for the first time, the recommended treatment is a combination of three drugs. The recommended combination of anti-HIV drugs for people taking HIV for the first time is two NRTIs and one drug from another class. The preferred NRTIs are tenofovir (Viread) and emtricitabine (FTC, Emtriva) or lamivudine (3TC, Epivir) and abacavir (Ziagen). Tenofovir and emtricitabine come in a combined pill called Truvada. Lamivudine and abacavir come in the combination pill Kivexa.

The preferred third drugs are atazanavir (boosted with ritonavir), darunavir (boosted with ritonavir), dolutegravir, elvitegravir (boosted with cobicistat), raltegravir or rilpivirine. An alternative third drug is efavirenz.

You can find out more about these drugs in the NAM booklet, Anti-HIV drugs, or by using My drugs chart, an online tool to create a personalised drug chart.

Other options if you are starting treatment for the first time

Your doctor may suggest you start treatment on a different drug combination to the ones described above.

There may be reasons why one of the combinations recommended for starting HIV treatment is not suitable for you. This could be because of possible interactions with other drugs you are taking, or because the strain of HIV you have is resistant to one or more drugs. Or it could be because you want to avoid certain side-effects.

In some cases, if your doctor thinks it will work as well for you, they may suggest you start on a combination that costs less for the NHS to buy. Your doctor will only do this if they also think this combination will work for you.

The recommendations suggest some alternative combinations for people starting HIV treatment in certain circumstances.

Kivexa (a drug combining lamivudine and abacavir) is an acceptable alternative to Truvada if your viral load is below 100,000 copies/ml. You need to have a test before starting treatment with Kivexa to see if you have a gene associated with allergy to abacavir (see page 10 for more information). You must not take Kivexa if you have this gene.

Alternative choices for a third drug in the combination are:

  • Kaletra, the protease inhibitor lopinavir, boosted with ritonavir, taken in two pills containing the combined drugs

or

  • nevirapine (Viramune, Viramune prolonged-release or a generic version; see page 18 for more information), a drug in the NNRTI class

or

  • rilpivirine (Edurant). This is the latest drug in the NNRTI class

or

  • fosamprenavir (Telzir), also a protease inhibitor that needs to be boosted with ritonavir.

Tenofovir, emtricitabineand rilpivirine are also available in a fixed-dose combination tablet called Eviplera.

You can find out more about these drugs in the NAM booklet, Anti-HIV drugs, or by using My drugs chart, an online tool to create a personalised drug chart.

Taking your HIV treatment

Published March 2014

Last reviewed March 2014

Next review March 2017

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.