Table 1. Three Promising ARVs of the Next Generation
Drug NameInnovator CompanyDevelopment StagePotential Advantages
  • Very high barrier to resistance and better regimen durability

  • Reduced manufacturing cost

  • Reduced side effects compared with efavirenz

  • Potential for first- or second-line treatment

  • More rapid decrease in viral load may increase efficacy for prevention of mother-to-child transmission among women initiating ART late in gestation

  • Low dosage convenient for pediatric formulations

  • May not reduce efficacy of progestin-containing contraceptive implants, which is a possible concern with efavirenz

TAFGileadLate Phase III
  • Lower risk of renal and bone toxicity than TDF

  • Lower manufacturing cost than TDF

  • Potential for first- or second-line treatment, with possible greater efficacy than TDF for viruses resistant to some nucleosides/nucleotides

DoravirineMerckEarly Phase III
  • Lower rates of central nervous system adverse events than efavirenz reported in phase II studies

  • Possible low manufacturing cost given low dose

  • May have better activity against many non-nucleoside reverse transcriptase resistant isolates common in sub-Saharan Africa, leading to possible utility in second-line combinations

  • Characteristics (lack of food requirement, shorter half-life, lower potential for TB medication interactions) might make it a better partner for dolutegravir than rilpivirine as part of a simplified, low-cost 2-drug maintenance regimen

  • Abbreviations: ART, antiretroviral therapy; ARV, antiretroviral; TAF, tenofovir alafenamide fumarate; TB, tuberculosis; TDF, tenofovir disoproxil fumarate.