Updated DHHS Adult and Adolescent HIV Treatment Guidelines: Conversation with Dr. Paul Sax Presentation prepared by: Paul Sax, MD and Brian Wood, MD

What were the main reasons behind moving tenofovir-emtricitabine-efavirenz (Atripla) from the list of “Recommended” first-line ART options to the list of “Alternative” options?

Are you still prescribing tenofovir-emtricitabine-efavirenz (Atripla)?

What is your threshold to offer a change off tenofovir-emtricitabine-efavirenz (Atripla) for a patient who may be experiencing side effects?

What about the recommendation to avoid efavirenz in a woman of childbearing potential?

What were the main reasons behind moving the regimen of tenofovir-emtricitabine (Truvada) plus boosted atazanavir (Reyataz with Norvir) from the list of “Recommended” first-line ART options to the list of “Alternative” options?

What would if a patient is tolerating boosted atazanavir?

Has it been your experience that atazanavir-induced kidney stones can occur after significant time has passed since atazanavir initiation?

What are the benefits of boosted atazanavir?

How do you decide between the 5 different options on the current list of “Recommended” initial ART regimens? And why not give everyone dolutegravir?

If once-daily dosing of raltegravir were available, would the higher barrier to resistance of dolutegravir still make it more advantageous?

What do you think of the two NRTI-sparing regimens that are now listed in the guidelines and what do you do if you have a patient who cannot received tenofovir or abacavir?

Can you comment on potential benefits of tenofovir alafenamide (TAF)?

Can you give more detail as to your thoughts on the issue of potential cardiovascular risk with abacavir?

What is your strategy if you have a patient with persistent low-level viremia?

How much does cost enter into consideration when choosing an initial ART regimen?