Guidelines for people starting HIV therapy for the first time
Regardless of CD4 count, the expert panel of the U.S. Department of Health and Human Services recommends starting antiretroviral therapy (ART) as soon as possible after HIV is diagnosed. Most people starting HIV treatment for the first time (treatment-naïve) should take one of the following: Biktarvy, Dovato or Tivicay plus Descovy or Truvada. GO TO clinicalinfo.hiv.gov for more information.
RATING OF RECOMMENDATIONS
A: Strong
B: Moderate
C: Weak
RATING OF EVIDENCE
1: Data from randomized controlled trials.
2: Data from well-designed non-randomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies or regimen comparisons from randomized switch studies.
3: Expert opinion.
ABBREVIATIONS
CD4: CD4 T lymphocyte, “T cell”
HIV RNA: viral load
INSTI: integrase strand transfer inhibitor
NNRTI: non-nucleoside reverse transcriptase inhibitor
NRTI: nucleoside reverse transcriptase inhibitor
PI: protease inhibitor
GENERIC REGIMENS OR COMPONENTS AVAILABLE
(SEE “Class list”)
Epivir (lamivudine, 3TC)
Ziagen (abacavir, ABC)
Prezista (darunavir, DRV)
Emtriva (emtricitabine, FTC)
Norvir (ritonavir, RTV)
Viread (tenofovir disoproxil fumarate, TDF)
Truvada (emtricitabine/tenofovir disoproxil fumarate, TDF/FTC)
FOOTNOTES
a Or generic equivalent.
b COBI should be avoided in pregnancy because lower concentrations of COBI and its boosted drugs—EVG, DRV and ATV—have been observed during the second and third trimesters. For individuals with viral suppression who become pregnant while on a COBI-containing regimen and wish to remain on that regimen after counseling regarding lower drug concentration, frequent viral load monitoring is recommended. For further information, refer to the Perinatal Guidelines (clinicalinfo.hiv.gov).
The U.S. Department of Health and Human Services (HHS) produces several sets of clinical guidelines for HIV care:
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV
Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV
Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States
HHS also provides two sets of clinical guidance in HIV:
Guidance for Non-HIV-Specialized Providers Caring for Persons with HIV Who Have Been Displaced by Disasters (Such as a Hurricane)
Guidance for COVID-19 and People with HIV
In addition, guideline reports from the U.S. Centers for Disease Control and Prevention (CDC) are provided on these topics:
Pre-exposure prophylaxis (PrEP)
Occupational post-exposure prophylaxis (PEP)
Non-occupational post-exposure prophylaxis (nPEP)
GO TO clinicalinfo.hiv.gov.