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2018 recommendations on antiretrovirals and Tx for HIV infection

New drugs and new approaches to prevent and manage HIV infection necessitate an update to the International Antiviral (formerly AIDS) Society–USA (IAS-USA) recommendations, last published in 2016.

This report incorporates current data on new regimens and new approaches into recommendations for the treatment and prevention of HIV.

Abstract
Importance: Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection.
Objective: To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk.
Evidence Review: New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations.
Findings: ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV.
Conclusions and Relevance: Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

Authors
Michael S Saag; Constance A Benson; Rajesh T Gandhi; Jennifer F Hoy; Raphael J Landovitz; Michael J Mugavero; Paul E Sax; Davey M Smith; Melanie A Thompson; Susan P Buchbinder; Carlos del Rio; Joseph J Eron Jr; Gerd Fätkenheuer; Huldrych F Günthard; Jean-Michel Molina; Donna M Jacobsen; Paul A Volberding

[link url="https://www.iasusa.org/content/antiretroviral-drugs-treatment-and-prevention-hiv-infection-adults-2018-recommendations"]IAS-USA material[/link]
[link url="https://jamanetwork.com/journals/jama/fullarticle/2688574"]JAMA abstract[/link]

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