There are some fixed-dose pills that combine three antiretroviral drugs from more than one drug class. These allow many people to take their HIV treatment in one pill, once a day. They are often known as ‘single-tablet regimens’ or STRs. These single-tablet regimens may be offered by some clinics if you need specific drugs or your doctor thinks they may help you take your medication. In most cases, though, you will start treatment with several pills.

There are other combination pills combining two drugs from a single class. These can reduce the number of pills in someone’s treatment regimen, but they still need to be taken with at least one other drug as well. These combinations are listed earlier in this book.   

Atripla provides triple-drug combination treatment in one pill, taken once a day. It combines 200mg emtricitabine, 245mg tenofovir disoproxil and 600mg efavirenz (two NRTIs and one NNRTI). The dose is one pink tablet once a day. Alternatively, you may be prescribed a generic version of efavirenz and the combination pill Truvada (tenofovir/emtricitabine), which provides the same doses of the three drugs.

Tips on taking it: Take one tablet once a day. Atripla may cause confusion or dizziness (because of the efavirenz, which often happens during the first few weeks of taking it); people often find it helpful to take it before going to bed or earlier in the evening. It is recommended that Atripla should be taken on an empty stomach. You can take it with food if you find this reduces side-effects, but avoid taking it with a high-fat meal; this may increase absorption of the drug, potentially increasing side-effects.

Very common or common side-effects: Difficulty in sleeping, tiredness, abnormal dreams, impaired concentration, dizziness, rash, itching, nausea, vomiting, diarrhoea, dry mouth, headache, anxiety, depression, raised liver enzyme, creatine kinase and amylase levels, skin darkening, low blood phosphate levels, weakness, stomach pains, bloating, flatulence, indigestion, loss of appetite, raised blood sugar and triglyceride levels.

Rare side-effects: Allergic (hypersensitivity) reaction, lactic acidosis (too much lactic acid in the blood), psychosis, liver inflammation.

Resistance: Not suitable for anyone with resistance to NNRTIs.

Key drug interactions: Some drugs can interact with efavirenz and cause dangerous side-effects. Some examples are ergot alkaloids (used to treat migraine and cluster headaches and to control labour); midazolam (an anaesthetic); or St John's wort. Some drugs can interact with efavirenz and change blood levels of one or both drugs, so dose adjustments may be needed. These drugs include some drugs used to treat bacterial infections such as TB (including clarithromycin, rifabutin and rifampicin), anti-fungal treatments, anticonvulsants, statins, methadone, sertraline, calcium channel blockers, immunosuppressants and warfarin.

See the entries on emtricitabine, tenofovir and efavirenz for more information.

Eviplera provides triple-drug combination treatment in one pill, taken once a day. It combines 200mg emtricitabine, 245mg tenofovir disoproxil and 25mg rilpivirine, in one purplish-pink tablet. This is a combination of two NRTIs and one NNRTI. The dose is one tablet once a day, which must be taken with food.

Tips on taking it: Take one tablet once a day. Always take with food, such as your main meal of the day, otherwise you will not absorb enough rilpivirine and your treatment may fail.

Very common or common side-effects: Raised cholesterol and triglyceride levels, loss of appetite, depression, sleep disorders, abnormal dreams, sleepiness, nausea, vomiting, diarrhoea, dizziness, insomnia, headache, weakness, rash, itching, abdominal pain, dry mouth, fatigue, bloating, flatulence, changes in kidney function, raised liver enzyme, amylase and creatine kinase levels, low blood phosphate levels, skin darkening, low white blood cell count.

Rare side-effects: Lactic acidosis (too much lactic acid in the blood), kidney failure.

Key drug interactions: Do not take Eviplera with the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital or phenytoin or with St John’s wort. Eviplera should not be taken at the same time as the antibiotics rifampicin and rifabutin (often used to treat TB). Some other antibiotics can increase blood levels of rilpivirine.

Medicines that affect your stomach acidity can block the way Eviplera is absorbed:

• Don’t take proton pump inhibitors (PPIs) such as omeprazole or lansoprazole with Eviplera.
• Indigestion remedies called H2-blockers such as ranitidine (Zantac) should be taken at least 12 hours before or at least four hours after taking Eviplera and at the lowest effective dose possible. Speak to your pharmacist or doctor for more advice.
• If taking other indigestion remedies, such as Gaviscon or Rennies, or calcium supplements, it is important that these agents are taken at least two hours before or at least four hours after taking Eviplera, as they can prevent it being absorbed properly.
• Make sure your doctor knows if you are taking any indigestion medication, even if you don’t take it every day.

See the entries on emtricitabine, rilpivirine and tenofovir for more information.

Genvoya provides combination treatment in one pill, taken once a day. It combines 200mg of emtricitabine, 10mg of tenofovir alafenamide (TAF), 150mg of elvitegravir and 150mg of cobicistat, a boosting agent. The dose is one green tablet, once a day.

Tips on taking it: Take one tablet once a day, with food. If you take Genvoya without food you may not absorb enough elvitegravir and your treatment may fail.

Common or very common side-effects: Abnormal dreams, headache, dizziness, nausea, diarrhoea, vomiting, abdominal pain, flatulence, rash, tiredness.

Rare side-effects: Depression, swelling of the skin, face, lips, tongue or throat.

Resistance: Not suitable for people with resistance to raltegravir or elvitegravir.

Children: Genvoya can be taken by children aged 12 years and over, weighing 35kg or more.

Key drug interactions: You should not take any supplements that contain calcium, iron, magnesium, aluminium or zinc at the same time as Genvoya, as they will reduce the absorption of elvitegravir. Take them at least four hours apart from Genvoya. It is likely that the boosting agent contained in Genvoya, cobicistat, will interact with many other drugs, because of the way it works. If you are using any product that contains steroids such as inhalers, eye drops, skin creams or injections, discuss with your pharmacist, as the cobicistat in Genvoya may also boost steroid levels, leading to harmful side-effects.

The antibiotics used to treat TB, rifampicin and rifabutin, may reduce levels of tenofovir alafenamide; so may some anticonvulsants including phenytoin and phenobarbital.

See the entries on emtricitabine, tenofovir and cobicistat for more information.

Odefsey provides triple-drug combination treatment in one pill, taken once a day. It combines 25mg of rilpivirine, 200mg of emtricitabine and 25mg of tenofovir alafenamide (TAF). This is a combination of one NNRTI and two NRTIs. The dose is one grey tablet, once a day.

Tips on taking it: Take one tablet once a day. Always take with food, such as your main meal of the day, otherwise you will not absorb enough rilpivirine and your treatment may fail.

Common or very common side-effects: Difficulty in sleeping, abnormal dreams, depression, headache, dizziness, loss of appetite, nausea, abdominal pain, vomiting, dry mouth, indigestion, flatulence, diarrhoea, rash, tiredness, low white or red blood cell count, low platelet count, raised lipid or pancreatic enzyme or liver enzyme levels.

Rare side-effects: Severe rash and fever.

Resistance: Not suitable for use by people with NNRTI resistance.

Children: Odefsey can be taken by children aged 12 years and over, weighing 35kg or more.

Key drug interactions: It’s not recommended that rilpivirine be used in combination with other NNRTIs.

Do not take rilpivirine with the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital or phenytoin or with St John’s wort. Rilpivirine should not be taken at the same time as the antibiotics rifampicin and rifabutin (often used to treat TB). Some other antibiotics can increase blood levels of rilpivirine.

Medicines that affect your stomach acidity can block the way rilpivirine is absorbed:

• Don’t take proton pump inhibitors (PPIs), such as omeprazole or lansoprazole with Odefsey.
• Indigestion remedies called H2-blockers (such as ranitidine, Zantac) should be taken at least 12 hours before or at least four hours after taking Odefsey. Speak to your pharmacist or doctor for more advice.
• If taking other indigestion remedies (such as Rennies or Gaviscon) or calcium supplements, take them at least two hours before or four hours after taking Odefsey as they can prevent it being absorbed properly.
• Make sure your doctor knows if you are taking any indigestion medication, even if you don’t take it every day.

The antibiotics used to treat TB, rifampicin and rifabutin, may reduce levels of tenofovir alafenamide; so may some anticonvulsants including phenytoin and phenobarbital.

See the entries on rilpivirine, emtricitabine and tenofovir for more information.

Stribild provides combination treatment in one pill, taken once a day. It combines 200mg of emtricitabine, 245mg of tenofovir disoproxil and 150mg of elvitegravir, along with 150mg cobicistat, a boosting agent. The dose is one green tablet, once a day.

Tips on taking it: Take one tablet once a day, with food. If you take Stribild without food you may not absorb enough elvitegravir and your treatment may fail.

Common or very common side-effects: Nausea, diarrhoea, vomiting, abnormal dreams, headache, fatigue, dizziness, insomnia, rash, itching, abdominal pain, bloating, flatulence, constipation, sleepiness, weakness, skin darkening, low white blood cell count, low blood phosphate levels, raised triglyceride and blood sugar levels, and raised liver enzyme, amylase, creatinine or creatine kinase levels.  

Rare side-effects: Lactic acidosis (too much lactic acid in the blood), kidney failure.

Resistance: Not suitable for people with resistance to raltegravir or elvitegravir.

Key drug interactions: You should not take any supplements that contain calcium, iron, magnesium, aluminium or zinc at the same time as Stribild, as they will reduce the absorption of elvitegravir. Take them at least four hours apart. It is likely that the boosting agent contained in Stribild, cobicistat, will interact with many other drugs, because of the way it works. It will have a similar list of interactions to the booster drug ritonavir. See the protease inhibitor section for more detail, but this includes some commonly prescribed drugs such as certain antibiotics, antidepressants and hormonal contraceptives. If you are using any product that contains steroids such as inhalers, eye drops, skin creams or injections, discuss with your pharmacist, as the cobicistat in Stribild may also boost steroid levels, leading to harmful side-effects.

See the entries on emtricitabine, tenofovir and cobicistat for more detail.

Symtuza provides combination treatment in one pill, taken once day. It combines 800mg of darunavir, 150mg of cobicistat, 200mg of emtricitabine and 10mg of tenofovir alafenamide (TAF) in one yellow tablet. This a combination of a protease inhibitor (darunavir) boosted by cobicistat, and two NRTIs.

Tips on taking it: Take one tablet once a day, with food. If you take Symtuza without food you may not absorb enough darunavir and your treatment may fail.

Common or very common side-effects: Allergic (hypersensitivity) reaction, loss of appetite, abnormal dreams, diabetes, raised lipid or liver or pancreatic enzyme or creatinine levels, headache, dizziness, diarrhoea, nausea, vomiting, abdominal pain, bloating, indigestion, flatulence, facial swelling, rash, itching, aching joints or muscles, tiredness, feeling weak.

Rare side-effects: Severe rash with fever (Stevens-Johnson syndrome).

Resistance: Symtuza is suitable for people who have taken antiretroviral drugs before if they do not have any resistance to darunavir. Resistance to darunavir will mean resistance to all protease inhibitors.

Children: Symtuza can be taken by children aged 12 years and over, weighing 40kg or more.

Key drug interactions: See Protease inhibitors: drug interactions for further detail. If you are using any product that contains steroids such as inhalers, eye drops, skin creams or injections, discuss with your pharmacist, as the cobicistat in Symtuza may also boost steroid levels, leading to harmful side-effects.

The antibiotics used to treat TB, rifampicin and rifabutin, may reduce levels of tenofovir alafenamide; so may some anticonvulsants including phenytoin and phenobarbital.

See the entries emtricitabine, tenofovir, darunavir and cobicistat for more details.

Triumeq provides combination treatment in one light-purple tablet, taken once a day. It combines 50mg dolutegravir, 600mg abacavir and 300mg lamivudine in one oval tablet. This is a combination of two NRTIs and one integrase inhibitor.

Tips on taking it: Take one tablet once a day, with or without food, preferably in the morning.

Common or very common side-effects: Difficulty in sleeping, sleepiness, abnormal dreams, depression, headache, diarrhoea, nausea, fatigue, rash, itching, vomiting, stomach pain, dizziness, hair loss, depression, flatulence, abdominal pain, bloating, muscle pain and discomfort, joint pain, an irritated or runny nose, cough, indigestion, gastric reflux and loss of appetite.

Rare side-effects: Allergic (hypersensitivity) reaction, lactic acidosis (too much lactic acid in the blood), suicidal thoughts and behaviours.

Important warning: Abacavir and dolutegravir, two of the active ingredients in Triumeq, can cause a serious allergic (hypersensitivity) reaction involving rash and fever soon after starting treatment. It is important that you discuss this with your doctor or pharmacist, before taking Triumeq. Please see individual drug entries for more information.

Children: Triumeq can be taken by children aged 12 years and over, weighing 40kg or more.

Key drug interactions: You should not take antacids, to treat indigestion and heartburn, or multivitamins, calcium or iron supplements during the six hours before you take Triumeq, or for at least two hours after you take it.

Triumeq can affect the diabetic medicine metformin, so make sure you speak to your doctor about this before starting either drug. As with all antiretrovirals, speak to your clinic about all medicines you are taking or may take before you start Triumeq.

See the entries on dolutegravir, abacavir and lamivudine for more detail.