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JAMA. 2016 Jul 12;316(2):191-210. doi: 10.1001/jama.2016.8900.

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.

Author information

1
University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
2
University of Alabama at Birmingham, Birmingham.
3
University of California San Diego School of Medicine, San Diego.
4
Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia.
5
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
6
Southwest CARE Center, Santa Fe, New Mexico.
7
Alfred Hospital and Monash University, Melbourne, Australia.
8
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
9
AIDS Research Consortium of Atlanta, Atlanta, Georgia.
10
Massachusetts General Hospital and Harvard Medical School, Boston.
11
University of California Los Angeles.
12
University of California San Diego, La Jolla.
13
International Antiviral Society-USA, San Francisco, California.
14
University of California San Francisco.

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.

PMID:
27404187
PMCID:
PMC5012643
DOI:
10.1001/jama.2016.8900
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Günthard reports receipt of grants from the Swiss National Science Foundation, Swiss HIV Cohort Study, University of Zurich, Yvonne Jacob Foundation, and Gilead Sciences; fees for data and safety monitoring board membership from Merck; consulting/advisory board membership fees from Gilead Sciences; and travel reimbursement from Gilead, Bristol-Myers Squibb, and Janssen. Dr Saag reports receipt of grants from Bristol-Myers Squibb, AbbVie, Merck, Gilead Sciences, Janssen, and ViiV Healthcare and serving as a scientific advisor to Bristol-Myers Squibb, Merck, and Gilead. Dr Benson reports data and safety membership board membership for GlaxoSmithKline, grants to and/or contracts with her institution from Gilead Sciences and MBio, and scientific advisory board membership for MBio. Dr Eron reports receipt of grants from and/or service as a consultant to Bristol-Myers Squibb, Janssen, ViiV Healthcare, AbbVie, Gilead Sciences, and Merck. Dr Gallant reports grants from and/or service as a consultant to AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, Sangamo Biosciences, and ViiV Healthcare/GlaxoSmithKline. Dr Hoy reports advisory board fees paid to her institution from Gilead Sciences, ViiV Healthcare, Merck Sharp & Dohme, and AbbVie. Dr Mugavero reports receipt of grants from Bristol-Myers Squibb and fees for grant review from Gilead Sciences. Dr Sax reports consultancy/advisory board membership for AbbVie, Bristol-Myers Squibb, GlaxoSmithKline/ViiV Healthcare, Gilead Sciences, Janssen, and Merck and receipt of grants from Bristol-Myers Squibb, GlaxoSmithKline/ViiV Healthcare, and Gilead. Dr Thompson reports institutional research contracts between the AIDS Research Consortium of Atlanta and Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme, Pfizer, Roche Molecular Systems, Taimed, Tobira Therapeutics, and ViiV Healthcare; she received no payments directly from these entities. Dr Gandhi reports receipt of grants from Gilead Sciences, Merck, ViiV Healthcare, and EBSCO. Dr Landovitz reports service as a consultant to and nonfinancial support from Gilead Sciences. Dr Smith reports receipt of grants from and/or service as a consultant to ViiV Healthcare, FluxErgy, and Testing Talent Services. Dr Volberding reports scientific advisory board membership for Bristol-Myers Squibb and Gilead Sciences and data and safety monitoring board membership for Merck. No other disclosures were reported.

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