A 32-year-old man is newly diagnosed with HIV infection. CD4 count is 180 cells/μL, HIV RNA is 85,000 copies/mL. He has no opportunistic infections. HLA-B*57:01 testing is negative. According to current WHO/DHHS 2023 guidelines, the preferred first-line antiretroviral regimen is:

• A Efavirenz + tenofovir disoproxil + emtricitabine (EFV/TDF/FTC)
• B Lopinavir/ritonavir + zidovudine + lamivudine
• C Bictegravir + tenofovir alafenamide + emtricitabine (B/F/TAF) ✓
• D Dolutegravir + abacavir + lamivudine (HLA-B*57:01 negative)

Explanation

Current DHHS 2023 and WHO guidelines prefer INSTI-based regimens for treatment-naive HIV. Bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy) is a single-tablet once-daily regimen with high barrier to resistance, minimal drug interactions, and favorable renal/bone safety profile of TAF over TDF. ADVANCE and GS-1489 trials confirm superiority over dolutegravir-based regimens in some comparisons. DTG/ABC/3TC is also highly recommended but requires HLA-B*57:01 screening. EFV-based regimens are no longer preferred due to neuropsychiatric side effects. Boosted PI regimens are inferior to INSTI regimens in tolerability and resistance barrier.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.