Journal Article

Updated ART Recommendations for HIV Treatment and Prevention

THE BOTTOM LINE:

Every two years a group of recognized experts updates a document on recommended antiretroviral drugs for treatment and prevention of HIV . This year’s edition provides a detailed review of the most recent recommendation collected from over 500 sources. Among the highlights, although the 3-drug regimen for initial treatment remains  recommended, there is a trend to using a 2-drug regimen with an integrase inhibitor as an alternative.  Of interest, is the recommendation of using an injection regimen every 4 weeks with the option of every 8 weeks, pending approval.  Also, a long acting PrEP injection approach for 8 weeks is being considered by approval groups.  The article has general recommendations for older adults living with HIV as well as approaches to addressing COVID-19.  This article is a significant and useful resource.

ABSTRACT

IMPORTANCE: Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. 

OBJECTIVE To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. 

EVIDENCE REVIEW New evidence was collected since the previous International Antiviral (formerly AIDS) Society–USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. 

FINDINGS From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. 

CONCLUSION AND RELEVANCE Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

To view the full article, click here: https://jamanetwork.com/journals/jama/article-abstract/2771873

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The American Academy of HIV Medicine is a professional organization that supports the HIV practitioner and promotes accessible, quality care for all Americans living with HIV disease. Our membership of HIV practitioners and credentialed HIV Specialists™, HIV Experts™, and HIV Pharmacists™ provide direct care to the majority of HIV patients in the US.