[ix]NNRTI-based

If you are starting anti-HIV treatment for the first time you are recommended to start with the NNRTI efavirenz (Sustiva).

The reason why some doctors and people with HIV often prefer an NNRTI-based combination is that it has relatively few side-effects and is very easy to take. However, it is very easy to develop resistance to NNRTIs, and if you become resistant to one it’s unlikely you’ll benefit from using any of the currently available NNRTIs. However, etravirine, which will be approved soon, works in people who have resistance to efavirenz and nevirapine.

Nevirapine (Viramune) is an alternative NNRTI in some case. For example women who are pregnant or thinking of pregnancy, or people with mental health problems.

Etravirine (Intelence) is expected to be approved in the UK and Europe later in 2008. It will be an important treatment option for people with HIV that is resistant to the other NNRTIs.

Boosted protease inhibitor-based

Starting tratment with  a ‘boosted’ protease inhibitor is now only recommended for certain groups of people. 

A boosted protease inhibitor might be a good option for you if are infected with HIV that is resistant to NNRTIs or has a lot of resistance to NRTIs. Or if you are pregnant, or thinking about becoming pregnant. Efavirenz, the recommended NNRTI, can cause psychiatric side-effects, so a boosted protease inhibitor might be an option if you have a history of depression or mental health problems.

The recommended boosted protease inhibitors for people starting anti-HIV treatment are Kaletra (lopinavir/ritonavir),  fosamprenavir/ritonavir (Telzir) and saquinavir/ritonavir (Invirase).  [ix]Atazanavir/ritonavir (Reyataz) and darunavir/ritonavir (Prezista) are also options, but they haven't yet been formally approved for people taking anti-HIV drugs for the first time, although this may change.

Tipranavir/ritonavir (Aptivus) is only approved for people who've taken a lot of anti-HIV drugs. 

Indinavir can be boosted (although it isn't aproved for use in this way), but is now very rarely used and isn't recommended. The protease inhibitor nelfinavir (Viracept) cannot be boosted by ritonavir and is generally only used for the treatment of HIV in special circumstances.

Most British doctors think that it is probably best to start with a combination that involves a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted protease inhibitor.