Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society–USA Panel
Open accessAbstract
Importance: Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. Objective: To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. Evidence Review: New evidence collected since the International Antiviral Society-USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. Findings: ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. Conclusions and Relevance: Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.
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Guidelines from both the U.S. Department of Health and Human Services and the International AIDS Society-USA Panel recommend that all persons with HIV infection be offered effective ART as soon as possible.
“Guidelines from both the U.S. Department of Health and Human Services and the International AIDS Society–USA Panel recommend that all persons with HIV infection be offered effective ART as soon as possible, both to reduce morbidity and mortality and to prevent HIV transmission (413).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [413]
The Methods and When to Start sections identify this as an IAS-USA recommendation and advise starting ART as soon as possible after diagnosis. The Engagement in Care and ART Adherence section describes individual health benefits and prevention of sexual transmission through sustained viral suppression. Our copy does not establish what the U.S. Department of Health and Human Services guidelines recommend, and it notes clinical exceptions to immediate ART. (LLM, conf=0.86)
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Cited by
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
Dolutegravir plus two different prodrugs of tenofovir to treat HIV
Venter, W. D. F., Moorhouse, M., Sokhela, S., Fairlie, L., Mashabane, N., Masenya, M., Serenata, C., Akpomiemie, G., Qavi, A., Chandiwana, N., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1902824 · Cited by 723 · see citing works
- Authors
- Saag, M. S., Benson, C. A., Gandhi, R. T., Hoy, J. F., Landovitz, R. J., Mugavero, M. J., Sax, P. E., Smith, D. M., Thompson, M. A., Buchbinder, S. P., del Rio, C., Eron, J. J., Fätkenheuer, G., Günthard, H. F., Molina, J.-M., Jacobsen, D. M., & Volberding, P. A.
- Affiliations
- University of Alabama at Birmingham (US)
- University of California San Diego (US)
- Harvard University (US)
- The Alfred Hospital (AU)
- University of California, Los Angeles (US)
- Brigham and Women's Hospital (US)
- AIDS Research Consortium of Atlanta (US)
- University of California, San Francisco (US)
- Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia
- University of North Carolina at Chapel Hill (US)
- German Center for Infection Research (DE)
- University of Zurich (CH)
- Hôpital Saint-Louis (FR)
- International Antiviral Society–USA, San Francisco, California
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-07-24
- Volume
- 320
- Issue
- 4
- Pages
- 379
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6415748
- OpenAlex
- W2915372808
- Cited by
- 698
- References
- 132
- Citations by year
- 2026: 8 · 2025: 29 · 2024: 41 · 2023: 70 · 2022: 101 · 2021: 115 · 2020: 152 · 2019: 137 · 2018: 38 · 2017: 6
- FWCI
- 83.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- JAMA (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (acceptedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (acceptedVersion)
- eScholarship (California Digital Library) (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- UNC Libraries
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Institute of Mental Health (P30MH062512)
- National Institute of Allergy and Infectious Diseases (P30AI036214, P30AI050410, P30AI027763)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Keywords
- antiretroviral therapy, HIV infection, HIV prevention, pre-exposure prophylaxis, integrase strand transfer inhibitors, nucleoside reverse transcriptase inhibitors, treatment switching, drug resistance, CD4 cell count monitoring, HIV viral load, HIV testing, tenofovir disoproxil fumarate/emtricitabine, medication adherence
- MeSH terms
- Adult, Diagnosis, Differential, Fees, Pharmaceutical, Humans, HIV Infections, Advisory Committees, Anti-Retroviral Agents, Time-to-Treatment
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