IAS Updates HIV Antiretroviral Drugs Guidelines

The International Antiviral Society-USA has updated its guidelines on use of antiretroviral (ART) drugs to manage HIV.

The update to the group’s 2018 guideline focuses on patients aged 18 years and older and is the result of a literature review of evidence published from January 2019 to August 22, 2020.  

Among the recommendations:

• ART should be started as soon as possible following HIV diagnoses
• Most people with HIV should be given bictegravir/tenofovir and alafenamide/emtricitabine; dolutegravir plus, or dolutegravir/lamivudine
• During pregnancy, atazanavir/ritonavir, darunavir/ritonavir, dolutegravir, efavirenz, raltegravir, and rilpivirine are recommended.
• Before any treatment changes, the patient’s ART regimen, regimen tolerability, co-medications, food requirements, cost, and results from prior resistance tests should be reviewed.

The guidelines also includes considerations for those at risk for HIV.

• For at-risk individuals, pre-exposure prophylaxis with an oral regimen is recommended.
• An injection of cabotegravir every 8 weeks is also recommended for cisgender men and transgender women who have sex with men.

The guidelines also feature a new section on managing HIV in older patient populations, and considerations for ART therapy access given the COVID-19 pandemic.

“Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV,” the authors conclude.

—Leigh Precopio

Reference:

Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults. Published online October 14, 2020. JAMA Intern Med. Doi:10.1001/jama.2020.17025