Most adolescents will have commenced ART during earlier childhood and will transition to a fixed-dose combination (FDC) regimen during early adolescence. The FDC regimen chosen will depend upon comorbidities, potential for drug-drug interactions (e.g., with oral contraceptives), prior antiretroviral drug exposure, antiretroviral drug resistance profiles, and any antiretroviral drug intolerances. There is increasing evidence and experience in transitioning adolescents to an integrase-inhibitor FDC, though there remain concerns around dolutegravir use in young women who are either pregnant or planning to become pregnant, given the preliminary data suggesting an increased risk of neural tube defects in infants of mothers receiving dolutegravir during the periconception period.[9] Further research is underway to better evaluate this possible association.
For adolescents who initiate ART during adolescence there are established guidelines from the United States (https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/11/what-to-start) and Europe (https://www.chiva.org.uk/guidelines/penta-treatment-guidelines) that are readily available. The decision on which regimen to initiate will depend upon the readiness for adolescents to commence and be adherent to ART and the pill burden.