2023 Treatment Guide: Is it Time to Change Your HIV Regimen?

If your HIV meds are working well without any significant side effects or issues — that’s great! But if you are suffering from side effects or struggling with adherence, it’s typically safe to switch from one HIV regimen to another. With more options than ever before, including the new long-lasting injectables, it can be challenging to choose which treatment might be right for you — which is why it’s important to talk to your doctor or health care provider. Start the process by reading the following list on sensible reasons to switch gears on your regimen.

IF YOU ARE WORRIED ABOUT DRUG RESISTANCE

Some drugs offer more protection against resistance developing. Darunavir (a component of both Prezista and Prezcobix) stops the virus from mutating, and thus developing resistance. A three-year study of those taking Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) found no drug resistance. If you do develop a drug resistance, other HIV meds can still work for you. For example, long-acting injectables Trogarzo and Sunlenca can help fight multi-drug resistant HIV when added to a previously failing antiretroviral regimen.

IF YOU WANT TO REDUCE THE NUMBER OF MEDS YOU TAKE

Although three-drug regimens were once considered essential in preventing drug resistance, two-drug regimens have proven to be just as effective. Their advantages include fewer side effects and a reduction in toxicity associated with long-term drug therapies. These days, there a several one- and two-drug regimens that are higly effective and approved by the Food and Drug Administration.

IF YOU TAKE YOUR MEDS WITHOUT FOOD

A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (with protein or a hearty meal, rather than just a snack). If you don’t eat big meals or prefer to take your meds at bedtime instead, or if you often forget to take your meds when you go out or while traveling, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) or Triumeq (dolutegravir/abacavir/lamivudine).

IF YOU ALSO HAVE HEPATITIS C

According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but some HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously.

IF YOU ARE PREGNANT

Some HIV medications may increase risks of birth defects and the effect of others, like cabotegravir, on fetuses haven’t been well studied. In updated guidelines, the Department of Health and Human Services’ Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission recommend dolutegravir-based regimens for pregnant people, irrespective of trimester, and for people who are trying to conceive. Based on additional data, the panel now also recommends tenofovir alafenamide as a preferred NRTI for antiretroviral regimens in people who are pregnant or trying to conceive.

IF YOU HAVE KIDNEY OR LIVER PROBLEMS

Tenofovir disoproxil fumarate (TDF), brand name Viread, is a component of drugs including Atripla, Truvada, Stribild, and Complera and has been linked to kidney problems in susceptible individuals. Those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), like Biktarvy, Genvoya, Odefsey, or Descovy. Juluca has fewer overall side effects, but has seen some users develop new or worse liver problems.

IF YOU CAN’T DEAL WITH THE SIDE EFFECTS

Every medication has potential side effects — some minor, some life-threatening. Not everyone taking a certain medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are negatively affecting your daily life.

IF YOU ARE A PERSON OF COLOR

A sad truth is that few drug trials test the impact of a treatment on people of color, especially women. That’s what makes 2020’s BRAAVE study so remarkable. It involved 495 self-identified Black or African-American HIV-positive people (32 percent were cisgender women) who switched to Biktarvy from a variety of regimens. Virtually all of those who switched maintained viral suppression.

IF YOU ARE CONCERNED ABOUT GAINING WEIGHT

At CROI 2021, researchers shared more data confirming that some HIV drugs lead to weight gain. Taking integrase inhibitors (dolutegravir or raltegravir) was previously associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. Recent studies indicate, however, that tenofovir alafenamide, an NRTI, is linked to weight gain. Weight gain can also raise your risks of diabetes and heart disease, so if these are concerns of yours, remember to discuss them with your doctor.

IF YOU WANT TO STOP TAKING PILLS ALL TOGETHER

In 2021, the FDA approved Cabenuva (rilpivirine and cabotegravir), making it the first complete antiretroviral regimen that comes in an injection form. Doses are administered every two months at your doctor’s office.