Arv dose protocol
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antiretroviral ARV dosing protocol adults
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ARV dose HIV treatment regimen first line second line
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Here is a comprehensive overview of ARV (antiretroviral) dosing protocols for HIV treatment:
ARV Dosing Protocol
Overview
ARV regimens are broadly classified into preferred, alternative, and special situation options. Most regimens consist of a backbone (2 NRTIs) + a third agent (INSTI, NNRTI, or PI).
First-Line (ART-Naive) Preferred Regimens
Integrase Strand Transfer Inhibitor (INSTI)-Based (Preferred)
| Regimen | Dose | Notes |
|---|---|---|
| Bictegravir/TAF/FTC (Biktarvy) | 1 tablet once daily | With or without food |
| Dolutegravir + TAF/FTC (DTG + Descovy) | DTG 50 mg once daily + 1 Descovy tablet once daily | With or without food |
| Dolutegravir/Lamivudine (Dovato) | 1 tablet once daily | Not for baseline HIV RNA >500,000 or HBV co-infection |
| Cabotegravir + Rilpivirine (Cabenuva) | Monthly or every 2 months IM injection | For virologically suppressed patients only |
NNRTI-Based Regimens
| Regimen | Dose | Notes |
|---|---|---|
| Doravirine (DOR)/3TC/TDF (Delstrigo) | 1 tablet once daily | ART-naive or virologically suppressed (HIV RNA <50) on stable regimen, no prior treatment failure |
| Rilpivirine/FTC/TDF (Complera) | 1 tablet once daily with ≥500 kcal meal | ART-naive with baseline HIV RNA ≤100,000 copies/mL; or suppressed on 1st/2nd regimen |
| Efavirenz 600 mg/3TC/TDF (Symfi) | 1 tablet once daily | Take on empty stomach |
| Efavirenz 400 mg/3TC/TDF (Symfi Lo) | 1 tablet once daily | Take on empty stomach |
INSTI + NNRTI Single Tablet (INSTI-Based)
| Regimen | Dose | Notes |
|---|---|---|
| Elvitegravir/Cobicistat/FTC/TDF (Stribild) | 1 tablet once daily | Administer with food; for ART-naive or virologically suppressed (HIV RNA <50) with no prior failure |
| Doravirine (DOR) alone | 100 mg once daily | For ART-naive or virologically suppressed, no prior resistance to DOR |
Key Dosing Principles
- Start with preferred INSTI-based regimens — superior efficacy, tolerability, and barrier to resistance
- Assess for resistance before initiating (baseline genotype)
- Check HLA-B*5701 before abacavir use (to prevent hypersensitivity)
- Renal function (eGFR): TDF contraindicated if eGFR <50 mL/min; switch to TAF
- Food requirements:
- Efavirenz-based: empty stomach
- Rilpivirine-based: with ≥500 kcal meal
- Elvitegravir/cobicistat: with food
- Bictegravir, dolutegravir: no food restriction
Pediatric Weight-Based Thresholds
For adolescents, most adult fixed-dose combinations (FDCs) apply at ≥35 kg (some require ≥40 kg for efavirenz 600 mg regimens) per Use of Antiretroviral Agents in Pediatric HIV Infection guidelines (p. 434, 458).
Special Populations
| Situation | Modification |
|---|---|
| Pregnancy | DTG preferred; avoid EFV in 1st trimester |
| TB co-infection | Use EFV 600 mg-based regimen (avoid PIs); rifabutin if PI-based required |
| Renal impairment | TAF preferred over TDF; dose-adjust if needed |
| Hepatic impairment | Avoid PIs with severe hepatic disease |
| HBV co-infection | Include TDF or TAF (dual HBV/HIV active) |
Switching (Virologically Suppressed)
Patients may switch to single-tablet regimens such as Biktarvy, Dovato, or Delstrigo if:
- HIV RNA <50 copies/mL on a stable regimen
- No history of virologic failure
- No known resistance mutations to the new regimen's components
Sources: Use of Antiretroviral Agents in Pediatric HIV Infection (p. 434, 458); DHHS Adult and Adolescent ARV Guidelines.
Note: This is a clinical reference summary. Always consult current DHHS or WHO guidelines and individualize therapy based on patient-specific factors including resistance profile, comorbidities, drug interactions, and adherence considerations.
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