Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society–USA Panel
Huldrych F. Günthard,Michael S. Saag,Constance A. Benson,Carlos del Rio,Joseph J. Eron,Joel E. Gallant,Jennifer F Hoy,Michael J. Mugavero,Paul E. Sax,Melanie A. Thompson,Rajesh T. Gandhi,Raphael J. Landovitz,Davey M. Smith,Donna M. Jacobsen,Paul A. Volberding +14 more
TLDR
In this article, the authors provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis.Abstract:
Importance New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. Objective To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. Evidence Review A panel of experts in HIV research and patient care convened by the International Antiviral Society–USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Findings Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. Conclusions and Relevance Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.read more
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Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society–USA Panel
Michael S. Saag,Constance A. Benson,Rajesh T. Gandhi,Jennifer F Hoy,Raphael J. Landovitz,Michael J. Mugavero,Paul E. Sax,Davey M. Smith,Melanie A. Thompson,Susan Buchbinder,Carlos del Rio,Joseph J. Eron,Gerd Fätkenheuer,Huldrych F. Günthard,Jean-Michel Molina,Donna M. Jacobsen,Paul A. Volberding +16 more
TL;DR: 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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The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective.
TL;DR: It is posited that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.
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Coformulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide, for initial treatment of HIV-1 infection (GS-US-380–1490): a randomised, double-blind, multicentre, phase 3, non-inferiority trial
Paul E. Sax,Anton Pozniak,M. Luisa Montes,Ellen Koenig,Edwin DeJesus,Hans Jürgen Stellbrink,Andrea Antinori,Kimberly A. Workowski,Jihad Slim,Jacques Reynes,Will Garner,Joseph M. Custodio,Kirsten L. White,Devi SenGupta,Andrew T. A. Cheng,Erin Quirk +15 more
TL;DR: Results are reported from a study comparing initial HIV-1 treatment with bictegravir with a novel INSTI with a high in-vitro barrier to resistance and low potential as a perpetrator or victim of clinically relevant drug interactions, showing non-inferiority of the bictricitabine regimen to the dolutegravIR regimen.
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Evaluation of a mosaic HIV-1 vaccine in a multicentre, randomised, double-blind, placebo-controlled, phase 1/2a clinical trial (APPROACH) and in rhesus monkeys (NHP 13-19)
Dan H. Barouch,Dan H. Barouch,Frank Tomaka,Frank Wegmann,Daniel J. Stieh,Galit Alter,Merlin L. Robb,Merlin L. Robb,Nelson L. Michael,Lauren Peter,Joseph P. Nkolola,Erica N. Borducchi,Abishek Chandrashekar,David Jetton,Kathryn E. Stephenson,Kathryn E. Stephenson,Wenjun Li,Bette T. Korber,Georgia D. Tomaras,David C. Montefiori,Glenda Gray,Nicole Frahm,M. Juliana McElrath,Lindsey R. Baden,Jennifer Johnson,Julia Hutter,Edith Swann,Etienne Karita,Hannah Kibuuka,Juliet Mpendo,Nigel Garrett,Kathy Mngadi,Kundai Chinyenze,Frances Priddy,Erica Lazarus,Fatima Laher,Sorachai Nitayapan,Punnee Pitisuttithum,Stephan Bart,Thomas B. Campbell,Robert Feldman,Gregg Lucksinger,Caroline Borremans,Katleen Callewaert,Raphaele Roten,Jerald C. Sadoff,Lorenz Scheppler,Mo Weijtens,Karin Feddes-de Boer,Danielle van Manen,Jessica Vreugdenhil,Roland Zahn,Ludo Lavreys,Steven Nijs,Jeroen Tolboom,Jenny Hendriks,Zelda Euler,Maria G. Pau,Hanneke Schuitemaker +58 more
TL;DR: All vaccine regimens demonstrated favourable safety and tolerability and immunogenicity and protective efficacy against a series of six repetitive, heterologous, intrarectal challenges with a rhesus peripheral blood mononuclear cell-derived challenge stock of simian-human immunodeficiency virus (SHIV-SF162P3).
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Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection (GS-US-380-1489): a double-blind, multicentre, phase 3, randomised controlled non-inferiority trial
Joel E. Gallant,Adriano Lazzarin,Anthony Mills,Chloe Orkin,Daniel Podzamczer,Pablo Tebas,Pierre Marie Girard,Indira Brar,Eric S. Daar,David A. Wohl,Jürgen K. Rockstroh,Xuelian Wei,Joseph M. Custodio,Kirsten L. White,Hal Martin,Andrew T. A. Cheng,Erin Quirk +16 more
TL;DR: This double-blind, multicentre, active-controlled, randomised controlled non-inferiority trial aimed to assess the efficacy and safety of bictegravir coformulated with emtricitabine and tenofovir alafenamide as a fixed-dose combination versus co formulated dolutegravIR, abacavir, and lamivudine.
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Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
Bernard M. Branson,H. Hunter Handsfield,Margaret A. Lampe,Robert S. Janssen,Allan W. Taylor,Sheryl B. Lyss,Jill Clark +6 more
TL;DR: The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States.
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