A 28-year-old newly diagnosed HIV-positive individual (CD4 580 cells/µL, VL 45,000 copies/mL) with no OIs is ready to start ART. Which combination regimen is preferred per WHO 2021 and DHHS 2022 guidelines?
- A Efavirenz + tenofovir disoproxil fumarate + emtricitabine (EFV/TDF/FTC)
- B Dolutegravir + tenofovir alafenamide + emtricitabine (DTG/TAF/FTC) as preferred first-line ✓
- C Raltegravir + tenofovir alafenamide + emtricitabine
- D Lopinavir/ritonavir + zidovudine + lamivudine
Explanation
WHO 2021 and DHHS 2022 guidelines recommend dolutegravir (DTG)-based regimens as preferred first-line ART due to high barrier to resistance, excellent efficacy, tolerability, and low drug interaction profile. DTG/TAF/FTC (Biktarvy: bictegravir is the single-tablet equivalent) is the preferred regimen. EFV/TDF/FTC (previously WHO preferred) has been downgraded due to neuropsychiatric side effects and lower barrier to resistance. Raltegravir requires twice-daily dosing and has lower resistance barrier than DTG. Lopinavir/ritonavir is no longer recommended for naive patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.