From the Guidelines
The initial treatment approach for a 36-year-old male with a presumptive positive HIV test should begin with confirmatory testing, followed by initiation of antiretroviral therapy (ART) with a recommended first-line regimen of bictegravir or dolutegravir plus two nucleoside reverse transcriptase inhibitors (NRTIs), as outlined in the 2024 recommendations of the International Antiviral Society-USA panel 1. The patient should undergo comprehensive evaluation, including a medical history, physical examination, and laboratory tests such as CD4 count, HIV viral load, and screening for other sexually transmitted infections. Key considerations in the management of HIV infection include:
- Initiation of ART as soon as possible after diagnosis, with a preferred regimen consisting of an integrase strand transfer inhibitor (InSTI) and two NRTIs 1
- Baseline laboratory tests to guide therapy selection and monitor for potential side effects
- Counseling on medication adherence, potential side effects, and the importance of regular follow-up appointments
- Consideration of individual patient circumstances, such as concomitant diseases and conditions, potential for pregnancy, and cost, in guiding treatment choice 1 The goal of ART is to prevent HIV replication, allowing immune system recovery and reducing viral load to undetectable levels, which improves health outcomes and prevents transmission to others. Regular follow-up appointments are crucial to monitor the patient's response to therapy, adjust the treatment regimen as needed, and address any concerns or side effects. By following the recommended treatment approach and guidelines, healthcare providers can help individuals with HIV achieve optimal health outcomes and reduce the risk of transmission to others.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Evaluation and Treatment Approach
- The initial treatment approach for a 36-year-old male with a presumptive positive Human Immunodeficiency Virus (HIV) test involves antiretroviral (ARV) therapy, which has proven to inhibit HIV-1 infection, but not cure it 2.
- Among various Food and Drug Administration (FDA)-approved ARVs, nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) are most effective in limiting HIV-1 infection 2.
Treatment Options
- NRTIs are a critical component of the treatment regimen for HIV-1, and their mechanism of action and metabolism have been extensively reviewed 2.
- The use of NRTIs will continue to be critical for successful treatment and prevention of HIV-1 2.
Referral and Further Evaluation
- Further evaluation and treatment should be referred to a specialist, such as an infectious disease specialist, for proper management and monitoring of the patient's condition.
- The patient should undergo additional testing, including CD4 cell count and viral load measurements, to determine the severity of the infection and to monitor the effectiveness of treatment 2.