Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Antiretroviral Drugs for Management of HIV

JAMA; 2018 Jul 24/31; Saag, Benson, et al

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, according to updated recommendations of the International Antiviral Society‒USA Panel. Researchers evaluated new data and treatments and established updated recommendations for initiating therapy, monitoring those starting therapy, changing regiments, and preventing HIV infection for individuals at risk. Among the findings:

  • Antiretroviral therapy (ART) is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis.
  • Immediate initiation, 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.
  • CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and coinfections are recommended at specified points before and during ART.
  • Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV.

Citation:

Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults. 2018 recommendations of the International Antiviral Society–USA Panel. JAMA. 2018;320(4):379–396. doi:10.1001/jama.2018.8431.

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