Numerous studies have confirmed that it is safe, and sometimes highly important, to switch from one antiretroviral therapy to another. If you are already undetectable, you can switch without risking your viral suppression. If you are struggling to take your HIV medication as prescribed, having disconcerting side effects, dealing with a comorbidity (like high cholesterol or liver disease), experiencing certain health concerns, or have changing lifestyle issues (unusual work hours, use of certain drugs) then reevaluating your medications can be a smart choice — especially with so many new options available.
Take our Annual Treatment Guide with you to your next appointment and talk with your doctor about medications that may be right for you. A simple switch could be what you need to live your best and healthiest life. Here are some reasons why you might switch, and which drugs you might consider:
1. If you want to reduce the number of drugs you take. Although three-drug regimens were once considered essential in preventing the development of HIV drug resistance, new 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. “Limiting the number of drugs in any HIV treatment regimen can help reduce toxicity for patients,” Debra Birnkrant, M.D., director of the Division of Antiviral Products in the Food and Drug Administration’s Center for Drug Evaluation and Research, told Endpoints News. Juluca (dolutegravir/rilpivirine) is the first two-drug regimen approved by FDA for adults already on treatment and virally suppressed.
2. If you don’t take your meds with food. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (protein or a hearty meal, rather than a snack). So if you’re the kind of person who either doesn’t eat that way or forgets your meds until later, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/tenofovir disoproxil fumarate).
3. If you are concerned about gaining weight. At the 2019 Conference on Retroviruses and Opportunistic Infections in Seattle, researchers from the North American AIDS Cohort Collaboration revealed that among people just starting treatment, taking integrase inhibitors (dolutegravir or raltegravir) was associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. If you are already struggling with your weight, avoid drugs like Triumeq (abacavir/dolutegravir/lamivudine) and opt for something like Truvada.
4. If you need to be more heart healthy. Some drugs, like Triumeq, come with certain cardiovascular risks, so those with higher risks of heart disease should instead consider tenofovir-based medications, such as Stribild (elvitegravir/ cobicistat/emtricitabine/tenofovir disoproxil fumarate) or Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide).
5. 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 many 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.
6. If you work odd hours, drink heavily, or use recreational drugs. People with unusual schedules, who binge-drink, or who use recreational drugs run the risk of missing their daily dose by time specified or altogether. Avoid medications that must be taken at the same time or with a meal, or are prone to drug resistance. Prezcobix (darunavir/cobicistat), Truvada, and Biktarvy are potential choices, but if you’re a heavy drinker, note that the latter two can both impact renal function.
7. If you have kidney or liver problems. Tenofovir disoproxil fumarate (TDF, brand name: Viread, and a component in the single-tablet regimens Truvada, Atripla, Complera, and Stribild) has been linked to kidney problems in susceptible individuals, so those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), such as Genvoya, Odefsey, and Descovy. Juluca, which overall promises fewer side effects, has seen some users develop worse or new liver problems.
8. If you can’t deal with the side effects. Every medication has potential side effects—some minor, some life-threatening. Not everyone taking the 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 impacting your daily life.
9. If you are worried about developing drug resistance. Some drugs have a higher risk of resistance and only need one mutation for the virus to gain complete resistance. This is particularly true with nonnucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (raltegravir), and some nucleoside analogs like 3TC and FTC. Other drugs offer more protection against HIV developing resistance. For example, the ODIN trial found that darunavir (a component of both Prezista and Prezcobix) stops the virus from multiplying and mutating. (Symtuza also offers a high barrier to resistance, but it’s only for those just starting treatment, not folks looking to switch).
10. If you already are drug-resistant. Just because you’ve developed a resistance to one drug, or even a whole class of drugs, doesn’t mean that other HIV meds won’t work for you. For example, Trogarzo (ibalizumab) a newly approved long-acting injectable, fights multidrug-resistant HIV when added to a previously failing antiretroviral regimen.
Note: You may have noticed from above that some of these seem a bit contradictory — for example, although Biktarvy includes tenofovir alafenamide like Descovy, the former is not recommended for those who have kidney problems while the latter is. Studies aren’t always conclusive, combination drugs can come with different recommendations than their individual elements, and if you have more than one health concern (like most of us) you and your doctor will have to decide which is most important in picking the right HIV medication to use. Keep in mind that if the antiretroviral therapy you and your doctor choose doesn’t turn out to be ideal, you can always switch again.