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
UAB

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 

Citation:

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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