HIV Prevention and Treatment with ART: International Antiviral Society Updates Recommendations
Am Fam Physician. 2019 Mar 15;99(6):395-396.
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Key Points for Practice
• ART should be prescribed and treatment barriers addressed soon after HIV infection is diagnosed.
• Before starting treatment, obtain HIV-1 RNA levels and a CD4 cell count; test for viral hepatitis, and perform blood chemistry testing and HIV genotyping for reverse transcriptase inhibitors and protease inhibitors.
• Assess treatment history, tolerance of various treatment options, other current medications, and results of previous resistance testing before changing therapy.
From the AFP Editors
Antiretroviral therapy (ART) is the key to preventing and managing human immunodeficiency virus (HIV) infection. Based on the availability of new medications and treatment options, the USA Panel of the International Antiviral Society has updated its 2016 recommendations. The full guidance addresses when to start ART in patients with active opportunistic infection or malignancy; appropriate regimens, including in unique situations (e.g., pregnancy); switching regimens; laboratory monitoring; patient engagement and adherence; cost considerations; HIV infection prevention; and future directions.
The following recommendations are based on evidence from at least one randomized controlled trial from a peer-reviewed journal. Unless a person has expressed interest in not initiating treatment, physicians should prescribe ART immediately after HIV infection is diagnosed, including addressing treatment barriers to allow for ART initiation at the first office visit as appropriate. Most persons with opportunistic infections should receive ART within two weeks of diagnosis. Before starting treatment in any patient, HIV-1 RNA measurement; CD4 cell count; HIV genotyping for nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs, and protease inhibitors; laboratory testing to identify active viral hepatitis; and blood chemistry testing should be performed; treatment may be initiated while awaiting results. If planning to prescribe abacavir (Ziagen), testing for HLA-B*5701 allele also should be performed and results obtained. If a patient has a CD4 count lower than 200 cells per μL (0.20 × 109 per L), he or she should receive prophylaxis for Pneumocystis pneumonia. Pregnant women with HIV infection should start ART for their own benefit, as well as to reduce the risk of transmission to the fetus.
All of the following primary regimen options have similar evidence supporting their
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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