We recommend that therapy-naïve PLWH start ART containing two nucleoside reverse transcriptase inhibitors (NRTIs) plus one of the following: ritonavir-boosted protease inhibitor (PI/r), non-nucleoside reverse transcriptase inhibitor (NNRTI) or integrase inhibitor (INI).

Summary recommendations for choice of ART:

Preferred Alternative
NRTI backbone Tenofovir-DF and emtricitabine**

Tenofovir-AF and emtricitabine

Abacavir and lamivudine*†
Third agent Atazanavir/ritonavir

Efavirenz

Dolutegravir
Darunavir/ritonavir
Elvitegravir/cobicistat**
Raltegravir

Rilpivirine^

*Abacavir is contraindicated if HLA-B*57:01 positive.

† Recommended only if baseline viral load is <100,000 copies/mL except when initiated in combination with dolutegravir in which case abacavir/lamivudine can be used at any baseline viral load.

** TDF-DF/FTC/E/C should not be initiated in individuals with creatinine clearance <70mL/min.

tenofovir-AF/emtricitabine/elvitegravir/c fixed-dose combination should not be initiated in patients with estimated CrCl <30 mL/min

^ Recommended only if baseline viral load is <100,000 copies/mL. 

NB. The viral load advice for abacavir/lamivudine and rilpivirine applies only to initiating these agents in individuals with a detectable viral load – when these agents are used as a switch option in the context of viral load suppression the baseline viral load can be disregarded.