Choosing antiretroviral therapy, explained.

A clinical decision support tool and teaching companion for HIV physicians in the UK. It ranks regimens against BHIVA recommendations and the UK SmPCs, and shows every reason, citation, tablet and adverse effect behind the result.

Created by Saranga Sumathipala.

Clinical decision support → Enter the patient's virology, renal and hepatic function, co-infections, co-medications and preferences, and get ranked regimens with dosing, cautions and monitoring. Learn → Drug classes, pharmacology, SmPC monographs, tablet identification, interactions, resistance and worked cases.

Where antiretrovirals act

HIV-1 replication cycle and antiretroviral targets Seven steps from attachment to maturation, each labelled with the antiretroviral class that blocks it. CD4⁺ T cell Nucleus — host DNA provirus HIV virion new infectious virion Attachment & fusion gp120 binds CD4 then CCR5/CXCR4 Capsid transport & uncoating capsid docks at the nuclear pore Reverse transcription RNA → double-stranded DNA Integration integrase inserts provirus Transcription & translation host machinery makes viral RNA/protein Assembly & budding Gag/Gag-Pol at the membrane Maturation protease cleaves Gag-Pol Entry Capsid NRTI NNRTI INSTI Capsid PI

Click a drug class to see its mechanism, drugs and UK products.

Worked cases

Starting ART: an uncomplicated first presentation

A 31-year-old man diagnosed at a sexual health clinic. HIV RNA 48,000 copies/mL, CD4 520. HBsAg negative, HLA-B*57:01 negative, baseline resistance test shows no mutations.

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Hepatitis B co-infection with chronic kidney disease

A 58-year-old man, HBsAg positive, creatinine clearance 42 mL/min, type 2 diabetes on metformin, on atorvastatin. HIV RNA 120,000 copies/mL, CD4 310.

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Newly diagnosed in pregnancy

A 27-year-old woman at 14 weeks' gestation found to have HIV at antenatal screening. HIV RNA 30,000 copies/mL, CD4 450, HBsAg negative.

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Advanced HIV with tuberculosis on rifampicin

A 35-year-old man with pulmonary TB, started on rifampicin-based treatment 10 days ago. CD4 85, HIV RNA 250,000 copies/mL. Resistance test pending.

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Virological failure on an NNRTI regimen

A 41-year-old woman on efavirenz/emtricitabine/tenofovir disoproxil since 2019, suppressed until 2025; HIV RNA now 15,000 copies/mL. Resistance test: RT K65R, M184V, K103N.

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Switching to long-acting injectable therapy

A 29-year-old man suppressed for 3 years on Biktarvy, no previous failure, HBsAg negative and HBV-immune, who would prefer not to take daily tablets.

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