### What you need to know
A 59 year old man who has been living with HIV for 15 years has been taking tenofovir disoproxil fumarate/emtricitabine and dolutegravir once daily for 10 years, and has an undetectable HIV viral load. He smokes 10 cigarettes a day and has a body mass index (BMI) of 29. His risk of developing a heart attack or stroke over the next 10 years as calculated by the QRISK3 algorithm is 14%. He recently developed renal tubular dysfunction attributed to tenofovir use. Until recently, the standard options in HIV treatment guidelines included two non-nucleos(t)ide reverse transcriptase inhibitors. Tenofovir disoproxil fumarate would be inappropriate due to the presence of renal tubular dysfunction, and abacavir would be because of a high risk of cardiovascular event. What other HIV treatment options are available for this man?
HIV treatment or antiretroviral therapy (ART) has traditionally consisted of three active drugs (table 1). Where individuals have continued ac