Antiretroviral Therapy Regimens in the Philippines

First-Line ART Regimens

The American Academy of HIV Medicine recommends Dolutegravir (DTG)-based regimens as the preferred first-line therapy in the Philippines, offering higher rates of virological suppression and a high genetic barrier to resistance 1
The standard backbone consists of tenofovir disoproxil fumarate (TDF) with either lamivudine (3TC) or emtricitabine (FTC), as recommended by the World Health Organization 1

Efavirenz (EFV)/TDF/emtricitabine (or lamivudine) is available as an alternative regimen, according to the US Department of Health and Human Services 2, 3
Raltegravir plus TDF/emtricitabine (or lamivudine) may be used in specific situations, as suggested by the International AIDS Society 2, 4
Rilpivirine/TDF/emtricitabine is available for patients with pretreatment HIV RNA <100,000 copies/mL and CD4 count >200/μL, as recommended by the European AIDS Clinical Society 2, 5

Darunavir/ritonavir (or cobicistat) plus TDF/emtricitabine (or lamivudine) is available for patients with suspected resistance or those who cannot tolerate first-line regimens, according to the National Institutes of Health 6, 7
These regimens are particularly useful when integrase strand transfer inhibitor (InSTI) resistance is suspected, as noted by the Journal of the American Medical Association 8

For patients with TB co-infection, dolutegravir (50 mg twice daily) with TDF/FTC (or 3TC) is recommended during treatment with rifamycin-containing regimens, as suggested by the Centers for Disease Control and Prevention 8
Efavirenz (600 mg)-based regimens remain an option for TB co-infection due to fewer drug interactions, according to the World Health Organization 1

Dolutegravir plus TDF/FTC (or 3TC) is now considered safe during pregnancy, as recommended by the American College of Obstetricians and Gynecologists 8, 9
Efavirenz-based regimens are also considered safe during pregnancy, according to the National Institutes of Health 3, 8

For patients with renal impairment, TDF should be avoided or dose-adjusted if creatinine clearance is below 60 mL/min, as recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 1
Alternative backbones may need to be considered in these cases, according to the European Renal Association 1

HIV RNA level testing is recommended within 6 weeks of starting ART, as suggested by the Infectious Diseases Society of America 1
Regular monitoring for drug toxicities is essential, particularly renal function for patients on TDF, according to the National Kidney Foundation 1
For treatment failure, resistance testing is recommended while the patient is taking the failing ART regimen, as recommended by the International AIDS Society 9