Current WHO PEPFAR guidelines recommend which ART regimen as preferred first-line therapy for treatment-naive HIV-positive adults (including pregnant women)?
- A Efavirenz / tenofovir / emtricitabine (EFV/TDF/FTC)
- B Tenofovir disoproxil fumarate / lamivudine / dolutegravir (TDF/3TC/DTG) ✓
- C Zidovudine / lamivudine / nevirapine (AZT/3TC/NVP)
- D Lopinavir / ritonavir / tenofovir (LPV/r/TDF) for high viral load
Correct answer: B. Tenofovir disoproxil fumarate / lamivudine / dolutegravir (TDF/3TC/DTG)
Explanation
WHO 2021 guidelines and PEPFAR recommend TDF + 3TC (or FTC) + DTG (dolutegravir) as the preferred first-line ART regimen globally, including for pregnant women — based on superior virological suppression, resistance barrier, safety profile, and once-daily dosing. DTG replaced efavirenz as the integrase strand transfer inhibitor of choice after concerns about efavirenz CNS side effects and teratogenicity were outweighed by updated safety data showing DTG is safe in pregnancy. AZT/NVP is obsolete. LPV/r is second-line.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.