From the Guidelines
The recommended treatment for human immunodeficiency virus (HIV) seroconversion illness is immediate initiation of antiretroviral therapy (ART), regardless of symptoms, as stated in the 2025 guidelines 1. A typical first-line regimen includes two nucleoside reverse transcriptase inhibitors (NRTIs) such as tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC), plus an integrase strand transfer inhibitor (INSTI) like bictegravir or dolutegravir. Single-tablet regimens like Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) are preferred for better adherence. Treatment should begin as soon as possible after diagnosis, even during acute infection, as early ART reduces viral reservoir establishment, preserves immune function, and decreases transmission risk, as supported by the latest recommendations 1. Some key points to consider in the management of HIV seroconversion illness include:
- Early initiation of ART to reduce morbidity and mortality
- Selection of a suitable first-line regimen based on the latest guidelines and patient factors
- Importance of medication adherence to prevent drug resistance and ensure viral load suppression
- Regular monitoring for drug side effects and viral load suppression, typically at 4-8 weeks after starting therapy and then every 3-6 months once stable, as part of comprehensive care 1. Supportive care with antipyretics and analgesics may help manage symptoms like fever, headache, and myalgia during the acute phase. It is essential to weigh the potential benefits of early treatment against the potential risks, including adverse effects on quality of life and the development of drug resistance, as discussed in earlier guidelines 1. However, the most recent and highest quality study 1 prioritizes the initiation of ART as soon as possible after diagnosis to improve outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
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. 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. TIVICAY and TIVICAY PD are indicated in combination with: other antiretroviral agents for the treatment of human immunodeficiency virus type 1 (HIV‑ 1) infection in adults (treatment-naïve or -experienced) and in pediatric patients (treatment-naïve or -experienced but integrase strand transfer inhibitor [INSTI]-naïve)aged at least 4 weeks and weighing at least 3 kg
The recommended treatment for human immunodeficiency virus (HIV) seroconversion illness is a combination of antiretroviral agents. The specific drugs and dosages may vary depending on the patient's age, weight, and other factors.
- Tenofovir disoproxil fumarate 2 is indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents.
- Efavirenz 3 is also indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents.
- Dolutegravir 4 is indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents.
From the Research
Human Immunodeficiency Virus Seroconversion Illness
Overview of Treatment
The recommended treatment for human immunodeficiency virus (HIV) seroconversion illness involves the use of antiretroviral therapy (ART) [ 5, 6 ].
Initiating Antiretroviral Therapy
- Rapid initiation of ART is recommended, preferably at the time of HIV diagnosis, to reduce transmission, morbidity, and mortality [ 6 ].
- A tenofovir backbone combined with an integrase strand transfer inhibitor or protease inhibitor is recommended for rapid start initiation [ 6 ].
Antiretroviral Regimens
- Different ART regimens, including those based on protease-inhibitors, integrase-strand-transfer-inhibitors, and nonnucleoside-reverse-transcriptase-inhibitors, have been compared in terms of virological efficacy, immunological reconstitution, and tolerability [ 7 ].
- No significant differences were found in viral suppression and immunological recovery among these regimens [ 7 ].
Special Considerations
- Earlier ART initiation, especially during the earliest Fiebig stages, is associated with higher rates of long-term immunological recovery [ 7 ].
- Seroreversion, or the loss of HIV antibodies, can occur in subjects receiving ART during acute/early HIV infection, but does not indicate viral eradication [ 8 ].
Guidelines for Use of Antiretroviral Therapy
- The API consensus guidelines for use of antiretroviral therapy in adults recommend that ART be initiated in all symptomatic HIV-infected persons, regardless of CD4 counts and plasma viral load levels [ 9 ].
- In asymptomatic patients, ART should be offered when CD4 counts are less than 200/mm3 and considered in patients with CD4 counts between 200-250/mm3 [ 9 ].