Saag MS, et al. - Given the significance of antiretroviral therapy (ART) for the prevention and management of HIV infection, new data and treatments were evaluated to incorporate the information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. Observations suggest that clinical management and outcomes, for individuals at risk for and living with HIV, continue to improve with advances in HIV prevention and treatment with antiretroviral drugs.

Methods

• Via monthly PubMed and EMBASE literature searches up to April 2018, new evidence since the International Antiviral Society–USA 2016 recommendations were collected.
• The collected data was presented at peer-reviewed scientific conferences.
• The data was considered and previous recommendations were updated by a volunteer panel of experts in HIV research and patient care.

Results

• For virtually all HIV-infected individuals, ART is recommended as soon as possible after diagnosis.
• Adequate staffing, specialized services, and careful selection of medical therapy are needed for immediate initiation (eg, rapid start), if clinically appropriate.
• Recommendations suggest initiating therapy with an integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs), with any unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) steering choice of treatment.
• Before and during ART, CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections at specified points were recommended.
• Assessment of treatment history, tolerability, adherence, and drug resistance history is recommended if a regimen switch is indicated; 2 or 3 active drugs are recommended for a new regimen.
• Researchers recommend HIV testing at least once for anyone who has ever been sexually active, and more often for individuals at ongoing infection risk.
• For individuals at risk for HIV, preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended.