Which drugs, which combination?

Even though there are over 20 HIV drugs and hundreds of potential choices, only two main types of combination are recommended.

Guidelines recommend starting with either:

2 nukes + an NNRTI

or

2 nukes + a ritonavir-boosted PI

Within each class, only a few drugs or combinations are recommended.

Knowing about other options is important in case you have trouble with these main options.

First combination

The first combination offered in the UK usually includes:

efavirenz (an NNRTI) +
EITHER Truvada (tenofovir + FTC)
OR Kivexa (abacavir + 3TC)

This is because efavirenz is one of the best drugs at bringing down viral load and it is one pill, once-daily. Even though side effects are not straight-forward, the risk of serious side effects is low.

If you don't want to use efavirenz because of the type of side affects it causes or because you want to become pregnant, then the current choice is to use EITHER another NNRTI (nevirapine) OR a boosted PI.

Types of HIV drugs

Class	Description
RTIs or nukes	reverse transcriptase inhibitors – also called nucleoside or nucleotide analogues
NNRTIs	non-nucleoside reverse transcriptase inhibitors or non-nukes
PIs	protease inhibitors
EIs	entry inhibitors – CCR5 inhibitors are also entry inhibitors
INIs	integrase inhibitors

This is the web edition of the i-Base guide Introduction to combination therapy. This guide is available in UK clinics. You can order free printed copies or download a PDF version (516 Kb). Translations. Authors and credits. Glossary. Full section index.

Decisions relating to your treatment should always be taken in consultation with your doctor. Information in this guide is intended to support those discussions.