Current Standard of Care for HIV Treatment

Introduction to HIV Treatment

The current standard of care for HIV treatment is antiretroviral therapy (ART) with an integrase strand transfer inhibitor (InSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) for all HIV-infected individuals with detectable plasma virus, regardless of CD4 cell count, as recommended by the American Medical Association 1, 2

ART is recommended for all HIV-infected individuals with detectable plasma virus, regardless of CD4 cell count, according to the American Medical Association 1
Initiation of ART is recommended as soon as possible (rapid ART) after HIV diagnosis, ideally within 7 days, as suggested by the American Medical Association 1
Same-day ART initiation is feasible and recommended when resources permit, as it increases care retention and population-level viral suppression, as stated by the American Medical Association 1
For patients with acute HIV infection, immediate ART is strongly recommended due to the urgent need for viral suppression, as recommended by the American Medical Association 1

Dolutegravir/abacavir/lamivudine is a preferred first-line regimen, as recommended by the American Medical Association 3
Dolutegravir plus tenofovir alafenamide (TAF)/emtricitabine is a preferred first-line regimen, as recommended by the American Medical Association 3
Raltegravir plus TAF/emtricitabine is a preferred first-line regimen, as recommended by the American Medical Association 3

HLA-B*5701 testing must be performed before abacavir use; those who test positive should not receive abacavir, as recommended by the American Medical Association 3
InSTI-based regimens are preferred due to superior efficacy, tolerability, and higher genetic barrier to resistance compared to other drug classes, according to the International Antiviral Society 4, 5 is replaced with:
InSTI-based regimens are preferred due to superior efficacy, tolerability, and higher genetic barrier to resistance compared to other drug classes, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: InSTI-based regimens are preferred due to superior efficacy, tolerability, and higher genetic barrier to resistance compared to other drug classes 4, 5

HIV RNA level testing is recommended within 4-6 weeks of starting ART, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: HIV RNA level testing is recommended within 4-6 weeks of starting ART 5
After initial suppression, viral load monitoring should occur every 3 months until suppressed for at least a year, then every 6 months if adherence is consistent, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: After initial suppression, viral load monitoring should occur every 3 months until suppressed for at least a year, then every 6 months if adherence is consistent 5
CD4 cell count monitoring is recommended every 6 months until counts are above 250/μL for at least 1 year with viral suppression, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: CD4 cell count monitoring is recommended every 6 months until counts are above 250/μL for at least 1 year with viral suppression 5

Systematic monitoring of ART adherence is crucial for successful treatment, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: Systematic monitoring of ART adherence is crucial for successful treatment 5
Integration of directly observed ART in methadone maintenance programs and as a treatment strategy for persons with substance use disorders is recommended, as suggested by the American Medical Association 6

If viral load has not declined after starting ART, adherence and medication tolerability should be assessed, as recommended by the American Medical Association is not available, however, the International Antiviral Society was not mentioned, instead: If viral load has not declined after starting ART, adherence and medication tolerability should be assessed 5
If adherence appears sufficient but viral suppression is not achieved, genotypic resistance testing is recommended, as suggested by the American Medical Association 6

For patients with tuberculosis co-infection, timing of ART initiation should be carefully considered: within 2 weeks after tuberculosis treatment initiation for CD4 count below 50 cells/μL, as recommended by the American Medical Association 1
For patients with cryptococcal meningitis, ART should be started 4-6 weeks after antifungal therapy initiation, as recommended by the American Medical Association 1
For patients with cancer, immediate ART initiation is recommended with attention to drug interactions, as recommended by the American Medical Association 1

Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine is recommended for individuals at risk for HIV infection, as suggested by the American Medical Association 6
PrEP is recommended for populations whose annual HIV incidence is at least 2%, as suggested by the American Medical Association 6
A 1-week lead-in time with daily dosing is recommended for rectal, penile, and vaginal exposures, as suggested by the American Medical Association 6
Condoms remain essential for prevention of non-HIV sexually transmitted infections, as suggested by the American Medical Association 6

With current ART regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults, as reported by the American Medical Association 3, 7