Available Antiretroviral Therapy (ART) Regimens in the Philippines
Dolutegravir-based regimens are currently the first-line antiretroviral therapy available in the Philippines, typically combined with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) or emtricitabine (FTC). 1
First-Line ART Regimens in the Philippines
Generally Recommended Initial Regimens
- Dolutegravir (DTG)-based regimens are the preferred first-line therapy in the Philippines, offering higher rates of virological suppression and a high genetic barrier to resistance 2, 1
- The standard backbone consists of tenofovir disoproxil fumarate (TDF) with either lamivudine (3TC) or emtricitabine (FTC) 2, 1
Alternative First-Line Regimens
- Efavirenz (EFV)/TDF/emtricitabine (or lamivudine) is available as an alternative regimen 3
- Raltegravir plus TDF/emtricitabine (or lamivudine) may be used in specific situations 3
- Rilpivirine/TDF/emtricitabine is available for patients with pretreatment HIV RNA <100,000 copies/mL and CD4 count >200/μL 3
Second-Line and Alternative Regimens
Protease Inhibitor-Based Regimens
- Darunavir/ritonavir (or cobicistat) plus TDF/emtricitabine (or lamivudine) is available for patients with suspected resistance or those who cannot tolerate first-line regimens 3
- These regimens are particularly useful when integrase strand transfer inhibitor (InSTI) resistance is suspected 3
Other Available Options
- Nevirapine-based regimens may be available but are not preferred due to higher rates of adverse effects and lower genetic barrier to resistance 4
- Atazanavir/ritonavir-based regimens may be available for specific situations 5, 4
Special Considerations for ART in the Philippines
Tuberculosis Co-infection
- For patients with TB co-infection, dolutegravir (50 mg twice daily) with TDF/FTC (or 3TC) is recommended during treatment with rifamycin-containing regimens 3
- Efavirenz (600 mg)-based regimens remain an option for TB co-infection due to fewer drug interactions 2
Pregnancy
- Dolutegravir plus TDF/FTC (or 3TC) is now considered safe during pregnancy 3
- Efavirenz-based regimens are also considered safe during pregnancy 3
Renal Impairment
- For patients with renal impairment, TDF should be avoided or dose-adjusted if creatinine clearance is below 60 mL/min 2
- Alternative backbones may need to be considered in these cases 2
Monitoring and Management
- HIV RNA level testing is recommended within 6 weeks of starting ART 2
- Regular monitoring for drug toxicities is essential, particularly renal function for patients on TDF 2
- For treatment failure, resistance testing is recommended while the patient is taking the failing ART regimen 3
Challenges in ART Delivery in the Philippines
- HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs 1
- High burden of tuberculosis and hepatitis B virus co-infection complicate HIV management 1
- Despite expanded access to treatment hubs and primary HIV care facilities, barriers such as stigma and sociocultural factors remain 1
The Philippines has made significant progress in expanding access to modern ART regimens, with dolutegravir-based therapy now established as the preferred first-line treatment, aligning with global standards for HIV care and treatment.