Intended for healthcare professionals
Antiretroviral therapy regimens containing two active drugs rather than the traditional three or more are efficacious in treating HIV
Two-drug regimens are a particularly useful option when tenofovir alafenamide, tenofovir disoproxil fumarate, or abacavir cannot be used or are not optimal—for example, for people with high cardiovascular risk, renal impairment, or decreased bone mineral density
Many two-drug regimens can be used by people who are electively switching HIV treatment and have an undetectable viral load, and one regimen is licensed for people newly starting antiretroviral therapy
They are not suitable for people with HIV and hepatitis B co-infection, or in those with a history of HIV drug resistance or during pregnancy
One long acting injectable two-drug regimen is also available, but this may not be suitable in those with a high body mass index, certain viral subtypes, or with HIV drug resistance
A 59 year old man who has been living with HIV for 15 years has been taking tenofovir disoproxil fumarate/emtricitabine and dolutegravir once daily for 10 years, and has an undetectable HIV viral load. He smokes 10 cigarettes a day and has a body mass index (BMI) of 29. His risk of developing a heart attack or stroke over the next 10 years as calculated by the QRISK3 algorithm is 14%. He recently developed renal tubular dysfunction attributed to tenofovir use. Until recently, the standard options in HIV treatment guidelines included two non-nucleos(t)ide reverse transcriptase inhibitors. Tenofovir disoproxil fumarate would be inappropriate due to the presence of renal tubular dysfunction, and abacavir would be because of a high risk of cardiovascular event. What other HIV treatment options are available for this man?
HIV treatment or antiretroviral therapy (ART) has traditionally consisted of three active drugs (table 1). Where individuals have continued access to HIV care, ART has allowed …
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