Initial therapy for HIV: can less be more?

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Since combination antiretroviral therapy (ART) for HIV became standard of care in the mid-1990s, all recommended initial treatments contain three active drugs: two drugs from the nucleoside reverse transcriptase inhibitor (NRTI) class plus a third active drug with a different mechanism of action—a non-nucleoside reverse transcriptase inhibitor, or a protease inhibitor (typically boosted with ritonavir to improve pharmacokinetics), or an integrase inhibitor. This three-drug approach strikes the right balance between efficacy (as measured by rates of virological suppression) and the issues of toxicity and affordability (more drugs means more side-effects and higher costs).