2025 Step & Shelf Update: New HIV Treatment

HIV is a top-10 high-yield topic for Step & Shelf exams, and there's a new first-line treatment you need to know in 2025. Here's the simplified guideline:

What's IN

Integrase inhibitor-based regimens are now the clear first-line choice for most patients starting HIV therapy.

These typically combine:

In some cases, a simplified two-drug integrase-based regimen (dolutegravir + lamivudine) is acceptable, but avoid if:

What's OUT

Regimens based on:

Protease inhibitors (e.g., atazanavir)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs, e.g., efavirenz)

Older integrase inhibitors (raltegravir, elvitegravir)

These are out due to:

Higher risk of resistance

More side effects and drug interactions

Higher pill burden and less convenience

Bottom line: When in doubt, pick an integrase inhibitor-based regimen for first-line HIV treatment questions!

P.S. HIV treatment is super nuanced. Tons of caveats (e.g. standard integrase inhibitor-based regimens are risky in patients who have taken long-acting cabotegravir as PrEP). If you need extra practice, Ora has over 500 HIV questions so you can study the details until you feel confident!

Published: March 26, 2025

Ryan Phelps, MD

Founder & CEO at Ora AI