HIV Prevention: Recommendations Updated for Treatment, in 2022

Because people with HIV are living longer, management of comorbidities throughout the life span is increasingly important

In a special communication article published online in the Journal of the American Medical Association. The International Antiviral Society-USA Panel presents updated recommendations for antiretroviral drugs’ treatment and prevention of HIV.

Rajesh T. Gandhi, M.D., from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues updated the 2020 consensus recommendations on the use of antiretroviral drugs for treating and preventing HIV. Relevant evidence was reviewed, and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were included.

The authors note that antiretroviral therapy (ART) initiation is recommended as soon as possible after HIV diagnosis. Barriers to care should be addressed, including ensuring access to ART and adherence support. The mainstay of initial therapy remains integrase strand transfer inhibitor-containing regimens.

Long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every two months, is now an option for people who have achieved viral suppression with a daily oral regimen. Certain antiretroviral medications have been linked to weight gain and metabolic complications; novel strategies are needed to improve these complications.

Because people with HIV are living longer and confronting the health challenges of aging, managing comorbidities is increasingly important throughout the life span. Preexposure prophylaxis options include oral medications and a long-acting injectable agent, cabotegravir, for the first time. An equity-based approach is essential to address challenges, including recent global health emergencies such as the COVID-19 pandemic and pox virus outbreak.

“Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain,” the authors write.

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