INSTIbased
INSTI-based regimens are antiretroviral therapies that center on an integrase strand transfer inhibitor (INSTI) to treat HIV-1 infection. INSTIs block the integration of viral DNA into the host genome, preventing replication. The main INSTIs are dolutegravir, bictegravir, raltegravir and elvitegravir. Most regimens combine an INSTI with two NRTIs, and several are available as single-tablet formulations (for example, dolutegravir/emtricitabine/tenofovir alafenamide and bictegravir/emtricitabine/tenofovir alafenamide).
Efficacy: In trials and real-world use, INSTI-based regimens achieve virologic suppression comparable to other first-line regimens
Safety and interactions: Generally well tolerated; common adverse effects include headache and fatigue. Some agents have
Resistance and monitoring: Dolutegravir and bictegravir have relatively high genetic barriers to resistance; raltegravir and elvitegravir
Guidelines and use: INSTI-based regimens are widely recommended as first-line therapy in many guidelines. Choice depends