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 P. Buchbinder, Carlos Del Rio, Joseph J. Eron, Gerd Fätkenheuer, Huldrych F. Günthard, Jean Michel Molina, Donna M. Jacobsen, Paul A. Volberding

Research output: Contribution to journalReview ArticleResearchpeer-review

104 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)379-396
Number of pages18
JournalJAMA
Volume320
Issue number4
DOIs
Publication statusPublished - 24 Jul 2018

Cite this

Saag, Michael S. ; Benson, Constance A. ; Gandhi, Rajesh T. ; Hoy, Jennifer F. ; Landovitz, Raphael J. ; Mugavero, Michael J. ; Sax, Paul E. ; Smith, Davey M. ; Thompson, Melanie A. ; Buchbinder, Susan P. ; Del Rio, Carlos ; Eron, Joseph J. ; Fätkenheuer, Gerd ; Günthard, Huldrych F. ; Molina, Jean Michel ; Jacobsen, Donna M. ; Volberding, Paul A. / Antiretroviral drugs for treatment and prevention of HIV infection in adults : 2018 recommendations of the international antiviral society-USA panel. In: JAMA. 2018 ; Vol. 320, No. 4. pp. 379-396.
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abstract = "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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Saag, MS, Benson, CA, Gandhi, RT, Hoy, JF, Landovitz, RJ, Mugavero, MJ, Sax, PE, Smith, DM, Thompson, MA, Buchbinder, SP, Del Rio, C, Eron, JJ, Fätkenheuer, G, Günthard, HF, Molina, JM, Jacobsen, DM & Volberding, PA 2018, 'Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the international antiviral society-USA panel', JAMA, vol. 320, no. 4, pp. 379-396. https://doi.org/10.1001/jama.2018.8431

Antiretroviral drugs for treatment and prevention of HIV infection in adults : 2018 recommendations of the international antiviral society-USA panel. / Saag, Michael S.; Benson, Constance A.; Gandhi, Rajesh T.; Hoy, Jennifer F.; Landovitz, Raphael J.; Mugavero, Michael J.; Sax, Paul E.; Smith, Davey M.; Thompson, Melanie A.; Buchbinder, Susan P.; Del Rio, Carlos; Eron, Joseph J.; Fätkenheuer, Gerd; Günthard, Huldrych F.; Molina, Jean Michel; Jacobsen, Donna M.; Volberding, Paul A.

In: JAMA, Vol. 320, No. 4, 24.07.2018, p. 379-396.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Antiretroviral drugs for treatment and prevention of HIV infection in adults

T2 - 2018 recommendations of the international antiviral society-USA panel

AU - Saag, Michael S.

AU - Benson, Constance A.

AU - Gandhi, Rajesh T.

AU - Hoy, Jennifer F.

AU - Landovitz, Raphael J.

AU - Mugavero, Michael J.

AU - Sax, Paul E.

AU - Smith, Davey M.

AU - Thompson, Melanie A.

AU - Buchbinder, Susan P.

AU - Del Rio, Carlos

AU - Eron, Joseph J.

AU - Fätkenheuer, Gerd

AU - Günthard, Huldrych F.

AU - Molina, Jean Michel

AU - Jacobsen, Donna M.

AU - Volberding, Paul A.

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N2 - 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.

AB - 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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U2 - 10.1001/jama.2018.8431

DO - 10.1001/jama.2018.8431

M3 - Review Article

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EP - 396

JO - JAMA

JF - JAMA

SN - 0098-7484

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