HIV/AIDS Treatment Regimen in India

Evolution of ART Regimens

The shift to DTG-based regimens aligns with global guidelines that recognize the superior efficacy and higher genetic barrier to resistance of integrase strand transfer inhibitors (InSTIs) 1
This evolution mirrors the global convergence of HIV treatment guidelines between high-income and low/middle-income countries 2

DTG-based regimens are now recommended as initial therapy over non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens due to efficacy, tolerability, and resistance profile 1

In patients with renal impairment, TDF should be avoided or dose-adjusted if creatinine clearance is below 60 mL/min 3

Boosted protease inhibitors like darunavir/ritonavir, though these have more side effects and drug interactions 4

HIV RNA level testing is recommended within 6 weeks of starting ART 5
Regular monitoring for drug toxicities is essential, particularly renal function for patients on TDF 6
Regular monitoring for drug toxicities is essential, particularly neuropsychiatric symptoms for patients on EFV 6

For failure of NNRTI-based regimens, DTG plus active NRTIs is superior to protease inhibitor-based regimens 5
For failure of InSTI-based regimens, boosted PI with active NRTIs is recommended 5
Virological failure should be confirmed with repeat testing, and adherence counseling should be reinforced before switching regimens 1

The World Health Organization recommends that the standard first-line regimen in India was previously tenofovir disoproxil fumarate (TDF) with either emtricitabine (FTC) or lamivudine (3TC) combined with efavirenz (EFV) 7, 8

The National AIDS Control Organization notes that DTG-based regimens have higher rates of virological suppression compared to other regimens, with a high genetic barrier to resistance development 9, 10

The American Society of Infectious Diseases states that 3TC is well-tolerated and has comparable efficacy to emtricitabine when used in combination regimens 11

The Centers for Disease Control and Prevention recommends HIV RNA level testing within the first 6 weeks of starting ART, then every 3 months until <50 copies/mL for 1 year, then every 6 months, and baseline resistance testing (HIV RT-pro genotype) before initiating therapy 12, 9

The World Health Organization suggests that for patients with tuberculosis co-infection, efavirenz-based regimens may still be considered due to fewer drug interactions with TB medications 13
The American College of Obstetricians and Gynecologists notes that for pregnant women or those planning pregnancy, careful consideration is needed due to historical concerns about neural tube defects with DTG, though recent data shows reduced risk over time 10