What is the standard treatment for a patient diagnosed with Human Immunodeficiency Virus (HIV)?

From the Guidelines

The standard treatment for HIV is antiretroviral therapy (ART), which should be initiated immediately after diagnosis, regardless of CD4 count, and continue lifelong. The current recommended initial regimen often includes an integrase strand transfer inhibitor (INSTI) such as dolutegravir or bictegravir, combined with two nucleoside reverse transcriptase inhibitors (NRTIs), commonly tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine or lamivudine 1. Many patients now receive these medications as single-tablet regimens like Biktarvy (bictegravir/tenofovir alafenamide/emtricitabine) or Triumeq (dolutegravir/abacavir/lamivudine) taken once daily.

Key Considerations

• Before starting therapy, baseline laboratory tests including CD4 count, viral load, resistance testing, and screening for hepatitis B, hepatitis C, and tuberculosis should be performed 1.
• Regular monitoring of viral load (every 3-6 months) and CD4 count is essential to ensure treatment effectiveness 1.
• ART works by preventing HIV from replicating, which preserves immune function, reduces inflammation, prevents progression to AIDS, and eliminates the risk of sexual transmission when viral suppression is achieved.
• Adherence to medication is crucial for treatment success and preventing drug resistance 1.

Additional Options

• Long-acting injectable therapy is available for those who prefer not to take daily oral medications and for people struggling with adherence to daily therapy 1.
• Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV 1.

From the FDA Drug Label

Efavirenz in combination with other antiretroviral agents is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and in pediatric patients at least 3 months old and weighing at least 3.5 kg. Tenofovir disoproxil fumarate is indicated in combination with other antiretroviral agents for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and pediatric patients 2 years of age and older weighing at least 10 kg.

The standard treatment for a patient diagnosed with Human Immunodeficiency Virus (HIV) typically involves a combination of antiretroviral agents.

• Efavirenz 2 and tenofovir disoproxil fumarate 3 are two such agents, often used in combination with other medications to treat HIV-1 infection in adults and pediatric patients.
• The dosage and administration of these medications vary based on factors such as age, weight, and renal function.
• It is essential to follow the recommended dosage and administration guidelines for each medication, as outlined in the drug labels, to ensure effective treatment and minimize potential side effects.

From the Research

HIV Symptoms and Treatment

• The symptoms of HIV infection can vary, but in 65 to 95% of cases, primary HIV infection (PHI) causes acute retroviral syndrome presenting with unspecific flu-like symptoms 4.
• Symptomatic PHI is associated with a faster clinical and immunological progression of HIV infection 4.
• The standard treatment for a patient diagnosed with HIV involves antiretroviral therapy (ART) to suppress viral load and stop the progression and transmission of HIV-1 5.

Antiretroviral Therapy (ART) Regimens

• Recommended ART regimens in primary HIV infection are combinations of tenofovir and emtricitabine with either darunavir/ritonavir, or dolutegravir 4.
• Other ART regimens, such as lopinavir/ritonavir combined with raltegravir or tenofovir/emtricitabine, have also shown efficacy in treating HIV-infected patients 6.
• The choice of ART regimen may depend on various factors, including the patient's viral load, CD4 cell count, and medical history 5, 7.

Treatment Outcomes

• Early ART started during primary HIV infection can prevent HIV transmission and decrease viral and immunological reservoir constitution 4.
• ART regimens have been shown to be effective in suppressing viral load and increasing CD4 cell counts in HIV-infected patients 6, 7.
• The efficacy and safety of different ART regimens, such as TAF/FTC/RPV, have been evaluated in clinical trials, and results have shown that these regimens can be used as initial regimens for people living with HIV 5.