Journal article
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel.
- Saag MS University of Alabama at Birmingham.
- Gandhi RT Harvard Medical School and Massachusetts General Hospital, Boston.
- Hoy JF Monash University and Alfred Hospital, Melbourne, Australia.
- Landovitz RJ University of California, Los Angeles.
- Thompson MA AIDS Research Consortium of Atlanta, Atlanta, Georgia.
- Sax PE Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.
- Smith DM University of California, San Diego, La Jolla.
- Benson CA University of California, San Diego, La Jolla.
- Buchbinder SP San Francisco Department of Public Health and University of California, San Francisco.
- Del Rio C Emory University School of Medicine, Atlanta, Georgia.
- Eron JJ School of Medicine, University of North Carolina, Chapel Hill.
- Fätkenheuer G University Hospital Cologne, Cologne, Germany.
- Günthard HF University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
- Molina JM University of Paris and Saint-Louis/Lariboisière Hospitals, APHP, Paris, France.
- Jacobsen DM International Antiviral Society-USA, San Francisco, California.
- Volberding PA University of California, San Francisco.
- 2020-10-14
Published in:
- JAMA. - 2020
AIDS-Related Opportunistic Infections
Age Factors
Anti-Retroviral Agents
Betacoronavirus
Comorbidity
Coronavirus Infections
Drug Administration Schedule
Drug Costs
Drug Resistance, Viral
Drug Substitution
Drug Therapy, Combination
Female
HIV Infections
Humans
International Agencies
Male
Pandemics
Pneumonia, Viral
Polypharmacy
Pre-Exposure Prophylaxis
Pregnancy
Pregnancy Complications, Infectious
RNA, Viral
Societies, Medical
United States
Viral Load
English
Importance
Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.
Objective
To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV.
Evidence Review
New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations.
Findings
From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic.
Conclusion and Relevance
Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.
Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.
Objective
To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV.
Evidence Review
New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations.
Findings
From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic.
Conclusion and Relevance
Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1001/jama.2020.17025
- PMID 33052386
- Persistent URL
- https://sonar.ch/global/documents/22837
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