New recommendations have been published on the use of antiretroviral therapy in adults with HIV – backing pre-exposure treatment for some people.
These new recommendations cover the timing of antiretroviral therapy initiation, the regimen to begin patients on and how regimens can be changed, and the role antiretroviral therapy can play in HIV transmission.
The authors of the document are led by Dr Huldrych Gunthard of University Hospital Zurich, Switzerland. It appeared in yesterday’s (12 July) issue of The Journal of the American Medical Association.
Dr Gunthard and the International Antiviral Society-USA panel say there have been substantial advances in the use of antiretroviral drugs since the last version of these recommendations in 2014. The team searched for and reviewed all reliable published work on the subject since 2014.
They support the recommendation that "antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count".
Furthermore, the ideal regimens for most patients to start on are two nucleoside reverse transcriptase inhibitors plus an integrase strand transfer inhibitor, they add.
The other effective regimens they suggest include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with two nucleoside reverse transcriptase inhibitors.
The authors also outline specific recommendations for special populations, and in the settings of opportunistic infections and other associated conditions.
They write: "Antiretroviral agents remain the cornerstone of HIV treatment and prevention. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals.
"With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults," they conclude.
Gunthard, H. F. et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA 12 July 2016 doi:10.1001/jama.2016. 8900 [abstract]
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