Over the past 40 years, there have been groundbreaking advances in the treatment of HIV. People with the infection should be treated as soon as possible following diagnosis. Antiretroviral therapy (ART) should be initiated after the treatment of any opportunistic infections that are present. Initially, ART involves daily oral therapy—typically with a combination including an integrase strand transfer inhibitor (InSTI). Long–acting injectable regimens can also be prescribed to patients who have attained viral suppression, with these injections administered every 2 months.

Two–drug regimens can also be considered, as they reduce the number of agents needed in a comprehensive ART regimen. They should consist of at least one antiretroviral agent with high potency and a high barrier to resistance. Although protease inhibitors (PIs) are non–inferior to three–drug regimens in terms of efficacy and exhibit high barriers to resistance, they are linked to cardiovascular/cerebrovascular disease, along with metabolic adverse effects such as dyslipidemia and insulin resistance. Moreover, drug-drug interactions with PIs can also be an issue.

What are your recommendations for a well–tolerated, unboosted, potent two–drug regimen with a high barrier to resistance for HIV?