Michael S. Saag, MD Professor,Division of Infectious Diseases UAB

Treatment and Prevention of HIV Infection Recommendations Updated

MedicalResearch.com Interview with:

Michael S. Saag, MD Professor,Division of Infectious Diseases UAB

Dr. Saag

Michael S. Saag, MD
Professor,Division of Infectious Diseases

MedicalResearch.com: What is the background for this study? What are the main findings? 

  • An update of prior recommendations made by the IAS-USA, which have been updated every 2 years since 1996
  • Cover ARVs for prevention and treatment of HIV infection
  • Developed by an international panel of 16 volunteer experts in HIV research and patient care appointed by the IAS–USA
    • Members receive no compensation and do not participate in industry promotional activities while on the panel
  • Primarily for clinicians in highly resourced settings; however, principles are universally applicable
  • Reviewed data published or presented from September 2016 through June 2018
  • Rated on strength of recommendation and quality of evidence

MedicalResearch.com: What should readers take away from your report?

  • Recommend initial regimens focus primarily on unboosted (InSTI) regimens
  • Encourage rapid initiation of ART, including ‘same day’ initiation, if feasible
  • Recommend against routine use of Mycobacterium avium complex prophylaxis for those with advanced disease on effective ART
  • Recommend discontinuation of routine CD4+  counts once a patient has sustained undetectable HIV RNA for a year and has a CD4+ count >250 cells/uL
  • Expand alternatives for preexposure prophylaxis for those who are uninfected with HIV but remain at risk for infection to include an episode-based “2-1-1” approach, where at risk individuals can take 2 ART pills prior to exposure followed by 1 pill once daily for 2 days after exposure (2-1-1)

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: I think the major changes are the recommendation to stop checking CD4 counts in those patients who have achieved and maintained viral load suppression for a year and have CD4 count values > 250 cells/ul; the recommendation to no longer use MAC prophylaxis; and the recommendation to use unboosted regimens whenever possible. 

Disclosures:  I am a Scientific Advisor to Merck, Gilead, and ViiV.  My institution has received grant support for HIV trials from BMS, Merck, Gilead, and ViiV 


Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2018 Recommendations of the International Antiviral Society–USA PanelJAMA. 2018;320(4):379–396. doi:10.1001/jama.2018.8431 

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Last Updated on July 25, 2018 by Marie Benz MD FAAD