The Grapevine

New HIV Treatment Guidelines Revealed By International Experts

A panel of experts commissioned by the International Antiviral Society–USA revealed new guidelines for treatment and prevention of HIV infection in adults.

The updated recommendations were published in the Journal of the American Medical Association on July 24. Dr. Michael Saag from the University of Alabama at Birmingham (UAB) was the lead author of the article.

"The recommendations reflect the joint commitment of researchers working to collectively improve clinical outcomes and treatments available for all at-risk or infected HIV patients," said Saag, professor of medicine in the Division of Infectious Diseases at UAB.

Antiretroviral therapy (ART) was reconfirmed as a substantial method for HIV treatment and prevention from the previous recommendations published in 2016. While it cannot kill or cure the virus, a combination of antiretroviral drugs can help prevent further growth. 

"We know that antiretroviral therapy is the cornerstone of prevention and management of HIV infection," Saag said, "but it's critical to continually evaluate new data and treatments for initiating therapy, monitoring individuals starting therapy, changing regimens and preventing HIV infection for those at risk, reaffirming the standard of providing the utmost treatment and care possible."

HIV treatment typically involves CD4 counts which are tests that measure the amount of CD4 cells (a type of white blood cell) the patient has in their blood. These cells perform the function of destroying bacteria, viruses, and other germs.

Routine lab tests are important as the count helps doctors estimate how much damage has been suffered by the immune system. The new report recommended discontinuing the test once the patient has sustained undetectable HIV RNA levels for a year and has a CD4 count above 250 cells

"HIV care continues to evolve, and clinicians and their patients benefit from applying the latest knowledge to keep pace with the many ways this has changed," said Paul Volberding, a professor at the University of California, San Francisco, and co-author of the report.

"The latest IAS-USA guidelines continue a tradition of providing a concise and current set of recommendations, and we are proud of how these have captured the directions in our field of medicine."

Among the updates, the panel recommended a primary focus on unboosted integrase strand transfer inhibitor (InSTI) regimens. They encouraged initiating ART as soon as possible, including same-day initiation if practical. Recommendations also went against the routine use of mycobacterium avium complex prophylaxis for patients with advanced disease on effective ART.

Moving forward, these guidelines are expected to be adopted by clinicians to improve clinical management and outcomes for HIV treatment. The updates on the report were targeted at adults who were over the age of 18, with or at risk for HIV infection with access to most antiretroviral drugs.