![]() Recommendations for when to start ART are reported in Box 1. This updated article provides current recommendations for treatment and prevention of HIV as well as an up-to-date discussion of important comorbidities and coinfections in people with HIV as they relate to the use of ART. To effectively address these and other challenges, as well as to realize the opportunity to end the HIV epidemic, efforts must be redoubled, with equity being the guiding principle. Other infectious disease outbreaks, such as COVID-19 and now monkeypox virus infection, also present rapidly evolving challenges for clinicians and people with HIV. Multidisciplinary and holistic care of people with substance use and substance use disorder is required to achieve optimal outcomes in treating and preventing HIV. As people with HIV live longer, there are important considerations related to aging that require an integrated approach. In addition to treatment improvements, there have been major advances in HIV prevention through preexposure prophylaxis (PrEP), including daily oral options and, for the first time, a long-acting injectable option, cabotegravir.Īs treatment and prevention of HIV improve, new challenges and opportunities arise. For patients who have achieved viral suppression, a long-acting injectable regimen (cabotegravir and rilpivirine ), which can be dosed every 2 months, is an option. Initial ART options include daily oral therapy, usually with a combination containing an integrase strand transfer inhibitor (InSTI). If they have an opportunistic infection, antiretroviral therapy (ART) should be started shortly after initiation of treatment of the infection. People with HIV should be treated as soon as possible after diagnosis. To address these and other challenges, an equity-based approach is essential.Ĭonclusions and Relevance Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.įour decades after the initial cases of HIV were reported, strategies for treating and preventing HIV infection continue to advance. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. Weight gain and metabolic complications have been linked to certain antiretroviral medications novel strategies to ameliorate these complications are needed. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. ![]() ![]() Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. Barriers to care should be addressed, including ensuring access to ART and adherence support. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.įindings Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. ![]() ![]() Objective Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.Įvidence Review A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Importance Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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