A 32-year-old HIV-positive man (CD4 52 cells/µL, viral load 85,000 copies/mL) is naive to antiretroviral therapy. He has no resistance mutations on genotype. According to WHO and DHHS 2024 guidelines, which preferred first-line ART regimen should be initiated?
- A Zidovudine + lamivudine + nevirapine
- B Efavirenz + tenofovir + emtricitabine
- C Bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) ✓
- D Lopinavir/ritonavir + two NRTIs
Correct answer: C. Bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC)
Explanation
Current DHHS 2024 and WHO preferred first-line regimens for treatment-naive HIV-positive adults favour integrase strand transfer inhibitor (INSTI)-based regimens: bictegravir/TAF/FTC (Biktarvy) or dolutegravir-based regimens (DTG/3TC or DTG + TAF/FTC) due to high potency, high genetic barrier to resistance, favourable tolerability, and once-daily dosing. The older efavirenz-based regimen (Atripla) and ZDV+3TC+NVP have lower barriers to resistance and more side effects. Lopinavir/ritonavir is no longer preferred due to GI tolerability and pill burden.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.