7.2.1 First-line ART for adults
Consolidated ARV guidelines, June 2013
Rationale and supporting evidence: HIV-2 infection
A systematic review of treatment options for individuals with HIV-2 (Web Annex) rated the evidence in all observational studies as being of very low quality, with serious risk of bias, inconsistency and imprecision.
Since HIV-2 is naturally resistant to NNRTIs, treatment-naive people coinfected with HIV-1 and HIV-2 should be treated with a regimen containing three NRTIs (TDF + 3TC (or FTC) + AZT or AZT + 3TC + ABC) or a ritonavir-boosted PI plus two NRTIs. If a PI-based regimen is used, the preferred option for first-line therapy should be LPV/r, since this will be procured in low-income settings for both second-line treatment for adults and for first-line treatment for children. SQV/r and DRV/r are alternative boosted-PI options, but they are not available as heat-stable fixed-dose combinations.