HIV Treatment and Prevention Guidelines

Introduction to HIV Management

The American Medical Association recommends immediate antiretroviral therapy (ART) initiation for all HIV-infected individuals regardless of CD4 count, integrase strand transfer inhibitor (InSTI)-based regimens as first-line therapy, and daily tenofovir disoproxil fumarate/emtricitabine for pre-exposure prophylaxis (PrEP) in high-risk individuals 1, 2

ART should be started in all HIV-infected individuals with detectable viremia as soon as possible after diagnosis, regardless of CD4 cell count, to prevent disease progression, improve clinical outcomes, and limit transmission 3, 4
The recommended optimal initial regimen for most patients consists of an integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) 1, 5
Alternative effective regimens include non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors with 2 NRTIs 3
When selecting a regimen, consider patient-specific factors including concomitant conditions, pregnancy potential, and cost 1

Before initiating ART, recommended laboratory tests include CD4 cell count, HIV RNA level, genotype testing, and screening for general health and co-infections 1
Ongoing monitoring during treatment is essential to assess response, detect adverse effects, and evaluate adherence 3
Laboratory assessments should be performed at specified intervals to ensure continued viral suppression and to detect any complications early 1

Reasons for switching therapy may include convenience and simplification of regimen, improved tolerability, anticipation of potential drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, and drug toxicities 3
When switching regimens, first assess treatment history, tolerability, adherence, and drug resistance history, and ensure the new regimen contains 2 or 3 active drugs 1

HIV testing is recommended at least once for anyone who has ever been sexually active and more frequently for individuals at ongoing risk for infection 1
Daily tenofovir disoproxil fumarate/emtricitabine is recommended as PrEP for individuals at high risk of HIV infection 1, 3
When indicated, post-exposure prophylaxis (PEP) should be initiated as soon as possible after exposure 3
PrEP requires appropriate monitoring to ensure safety and effectiveness 1

When used effectively, current ART regimens can sustain HIV suppression and prevent new HIV infections 3
With modern treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults 3

Adherence to ART is crucial for treatment success; approaches to improve linkage to and retention in care should be implemented 3