A 32-year-old man newly diagnosed with HIV has CD4 count 320 cells/µL and HIV-1 RNA 85,000 copies/mL. The preferred first-line ART regimen in India (NACO 2022 guidelines) for a treatment-naive patient without specific comorbidities is:

• A Zidovudine + Lamivudine + Nevirapine (AZT+3TC+NVP)
• B Tenofovir alafenamide + Emtricitabine + Dolutegravir (TAF+FTC+DTG)
• C Tenofovir disoproxil fumarate + Lamivudine + Dolutegravir (TDF+3TC+DTG) ✓
• D Abacavir + Lamivudine + Efavirenz (ABC+3TC+EFV)

Explanation

NACO (National AIDS Control Organisation) guidelines updated in 2022 recommend TDF+3TC+DTG as the preferred first-line ART regimen for adults and adolescents in India, replacing the older TDF+3TC+EFV or AZT-based regimens. Dolutegravir (integrase strand transfer inhibitor) has high potency, high genetic barrier to resistance, fewer CNS side effects than efavirenz, and once-daily dosing. TAF+FTC+DTG (option B) is preferred in Western guidelines but TAF is less available in Indian public sector programmes where TDF remains the nucleoside backbone.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.