Healthcare providers can treat HIV using antiretroviral therapy. A person may need to take several tablets a day or a single pill that contains multiple drugs.
In this article, we look at the benefits of single-tablet regimens (STRs). We also provide a list of drugs that doctors commonly prescribe in STRs.
Healthcare providers treat HIV with antiretroviral therapy, which involves a combination of drugs.
A person receiving HIV treatment usually takes two or more tablets every day. Each drug attacks the virus differently, and the combination is key.
A person following an STR takes a daily pill that contains a combination of two or more antiretroviral drugs.
The U.S. Food and Drug Administration (FDA) have approved over 30 drugs to treat HIV, and each works differently to prevent the virus from multiplying in the blood.
Some HIV regimens require people to take multiple pills per day. This may mean taking different tablets at different times, either with or without food.
An STR reduces this number of pills to one.
Taking a single pill each day, compared with two or more, can make it easier for a person to follow their treatment plan, making the antiretroviral therapy more effective.
Having more effective treatment and a streamlined medication routine and can improve a person’s quality of life.
For more in-depth information and resources on HIV and AIDS, visit our dedicated hub.
The list below provides details about medications commonly included in STRs. Each combination of drugs comes in a single daily pill.
Atripla
Formula:
- 600 milligrams (mg) efavirenz
- 200 mg emtricitabine
- 300 mg tenofovir disoproxil fumarate (tenofovir DF or TDF)
How to take it: Swallow the pill whole, on an empty stomach and at bedtime, as it can cause drowsiness.
Other information: Atripla is not suitable for people with mild to severe kidney or liver problems. It is also not suitable for people who weigh under 88 pounds, and it may not be right for people with depression or psychiatric conditions.
Common side effects:
- drowsiness
- dizziness
- unusual dreams
- loss of concentration
- diarrhea
- nausea
- fatigue
- sleep disturbances
- high cholesterol
- skin rash or itching
Biktarvy
Formula:
- 50 mg bictegravir
- 200 mg emtricitabine
- 25 mg tenofovir alafenamide (TAF)
How to take it: Take the pill with or without food, but do not take Biktarvy at the same time as, or within 2 hours of, taking antacids that contain aluminum, magnesium, or calcium.
Other information: Biktarvy is not suitable for people with severe liver or kidney problems.
Common side effects:
- diarrhea
- nausea
- headaches
Complera
Formula:
- 25 mg rilpivirine
- 200 mg emtricitabine
- 300 mg tenofovir disoproxil fumarate (tenofovir DF or TDF)
How to take it:Take the pill with a meal to ensure that the body absorbs the right amount of the drug. In this case, smoothies or protein drinks do not count as meals.
Other information:Taking Complera consistently is especially important, as the virus may find developing a resistance to it easier. Drug interactions can cause resistance to Complera. It does not increase cholesterol as much as some other medications, so it may be a good option for a person with a high risk of heart disease. It is not suitable for people who weigh under 77 pounds.
Common side effects:
- nausea
- vomiting
- diarrhea
- headaches
- rash
- depression
- anxiety
- fatigue
- dizziness
- drowsiness
- high cholesterol
- sleep disturbances
- dark spots on the skin, specifically the palms and the soles of the feet
Delstrigo
Formula:
- 100 mg doravirine
- 300 mg lamivudine
- 300 mg tenofovir disoproxil fumarate (tenofovir DF or TDF)
How to take it: Take Delstrigo with or without food.
Other information: This drug is not suitable for people with moderate to severe kidney or liver problems.
Common side effects:
- dizziness
- diarrhea
- nausea
- headaches
- unusual dreams
- difficulties sleeping
Genvoya
Formula:
- 150 mg elvitegravir
- 150 mg cobicistat
- 200 mg emtricitabine
- 10 mg tenofovir alafenamide (TAF)
How to take it: Take the pill with food.
Other information: A person should have their kidney function tested before taking Genvoya. It is not suitable for people with severe liver or kidney problems.
Common side effects:
- headaches
- nausea
- diarrhea
- fatigue
- high cholesterol
Juluca
Formula:
- 50 mg dolutegravir
- 25 mg rilpivirine
How to take it: Take the pill with a meal to ensure that the body absorbs the right amount of the drug. In this case, smoothies or protein drinks do not count as meals.
Other information: Juluca is intended for people with stable HIV who are ready to switch from a three-drug regimen to a two-drug regimen. This is the smallest STR pill available, making it the easiest to swallow. People with severe kidney problems may be able to take this medication, as long as they are closely monitored by a doctor.
Common side effects:
- headaches
- diarrhea
Odefsey
Formula:
- 25 mg rilpivirine
- 200 mg emtricitabine
- 25 mg tenofovir alafenamide (TAF)
How to take it: Take Odefsey with a meal to ensure that the body absorbs the right amount of the drug. In this case, smoothies or protein drinks do not count as meals.
Other information: This pill is small, making it easier to swallow. Taking Odefsey consistently is especially important, as the virus may find developing a resistance easier. It may be a good option for a person with a high risk of heart disease because it does not increase cholesterol as much as some other medications. Odefsey is not suitable for people who weigh under 77 pounds or for those with severe kidney problems.
Common side effects:
- nausea
- vomiting
- headaches
- a rash
- depression
- difficulties sleeping
- dizziness
Stribild
Formula:
- 150 mg of elvitegravir
- 150 mg cobicistat
- 200 mg emtricitabine
- 300 mg tenofovir disoproxil fumarate (tenofovir DF or TDF)
How to take it: Take the pill with food.
Other information: Stribild is not suitable for people with severe liver problems or moderate to severe kidney problems. Also, it is not safe for people who are pregnant or for those who weigh under 77 pounds.
Common side effects:
- nausea
- diarrhea
- unusual dreams
- headaches
- kidney damage
Symtuza
Formula:
- 800 mg darunavir
- 150 mg cobicistat
- 200 mg emtricitabine
- 10 mg tenofovir alafenamide (TAF)
How to take it: Take the pill with food.
Other information: Symtuza is not suitable for people with severe kidney problems or for those who are allergic to sulfonamides, which are sometimes called sulfa drugs.
Common side effects:
- diarrhea
- rash
- nausea
- high blood sugar
Triumeq
Formula:
- 50 mg dolutegravir
- 600 mg abacavir
- 300 mg lamivudine
How to take it: A person can take Triumeq with or without food. Do not take it within 2 hours before, or 6 hours after, consuming antacids, laxatives, iron pills, or calcium supplements.
Other information: Before taking Triumeq, a person should have a blood test for HLA-B*5701 to see if they are genetically likely to have an allergic reaction to the drug.
Common side effects:
- headaches
- fatigue
- difficulties sleeping
If a person has a resistance to integrase strand transfer inhibitors, or INSTIs, they will have to take an additional tablet.
Triumeq is not suitable for people who weigh under 88 pounds, for people with moderate to severe kidney problems, or for people with liver problems.
HIV drugs
A doctor will perform a blood test to check for the hepatitis B virus before prescribing HIV medication. Many of these drugs treat hepatitis B as well as HIV, so if a person stops taking one of these drugs, their hepatitis B may also get worse.
A healthcare provider can describe each drug in more detail and discuss possible side effects.
Some HIV drugs interact with other medications. Anyone about to start an STR should tell their healthcare provider if they are taking any prescribed or over-the-counter medicines, herbal remedies, or supplements.
All HIV regimens include a combination of drugs that fight HIV in different ways. They fall into the following categories:
- non-nucleoside reverse transcriptase inhibitors, or NNRTIs
- nucleoside reverse transcriptase inhibitors, or NRTIs
- integrase strand transfer inhibitors, or INSTIs
- protease inhibitors, or PIs
- entry inhibitors
- CCR5 antagonists
Research indicates that people taking single daily HIV pills, rather than two or more tablets per day, are more likely to keep to the regimen at least
This adherence is important because taking medication
People may experience more side effects from following STRs, compared to other regimens, because of the combination of drugs in a single tablet. This can also make it harder to determine which drug is causing the adverse effects.
Also, STRs contain fixed doses of the drugs, so a healthcare provider cannot adjust dosages. This makes STRs less suitable for people with existing medical conditions, such as kidney or liver problems.
Single vs. multiple pills
Recent evidence suggests that single pills may be more effective than combined pills. However, the research is mixed.
A 2018
The researchers measured HIV suppression after both groups had been taking the drugs for a year. They defined HIV suppression as having a viral load of fewer than 400 copies per milliliter.
The authors reported that 84.4 percent of participants using an STR had suppressed levels of HIV, compared with 77.6 percent of those using a multi-tablet regimen.
The researchers are unsure why the STRs had better results, as both groups followed their regiments with similar regularity. However, both regimens contained different combinations of drugs, which could have affected the results.
Another study found that people are simply more likely follow a treatment plan if it involves fewer pills. There was no evidence that an STR would suppress HIV better than a two-tablet daily regimen.
Identifying whether STRs are more effective and how they achieve different results from multi-tablet regimens will require further research.
Following an STR for HIV involves taking a daily pill that contains a combination of antiretroviral medications.
In general, people find it easier to take one tablet a day, rather than multiple tablets, so STRs can help people follow their treatment plans consistently, which is one of the most important factors for staying healthy with HIV.
When deciding upon the best HIV treatment regimen, a person and their healthcare team should consider:
- possible side effects
- any other current medications
- existing medical conditions
- whether a person has experienced prior resistance to HIV drugs
- how many pills a person will need to take each day
Discuss the options with healthcare providers, who will help identify the best course of treatment.