What is the recommended treatment course for individuals diagnosed with Human Immunodeficiency Virus (HIV)?

From the Guidelines

The recommended treatment for individuals diagnosed with HIV is immediate initiation of antiretroviral therapy (ART), regardless of CD4 count or viral load, with regimens composed of an integrase strand transfer inhibitor (InSTI) such as bictegravir or dolutegravir, plus two nucleoside reverse transcriptase inhibitors (NRTIs) 1.

Key Considerations

• The standard approach involves a combination of three antiretroviral medications, with InSTIs being the preferred class due to their high viral suppression rates, excellent tolerability, and low pill burden.
• Common first-line regimens include combinations like bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy), dolutegravir plus tenofovir/emtricitabine, or dolutegravir plus abacavir/lamivudine.
• Treatment is lifelong and requires strict adherence to prevent viral resistance.

Pre-Treatment and Ongoing Care

• Before starting treatment, patients should undergo baseline laboratory testing including CD4 count, viral load, resistance testing, and screening for other infections like hepatitis.
• Regular monitoring (every 3-6 months) of viral load, CD4 count, kidney and liver function is essential.
• 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.

Additional Recommendations

• Patients should receive vaccinations, regular screenings for sexually transmitted infections, and counseling on medication adherence and overall health maintenance.
• 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.
• Recommendations are provided for laboratory monitoring, management of substance use disorders and weight changes, as well as use of statins for cardiovascular disease prevention.

From the FDA Drug Label

BIKTARVY is indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in: adults and pediatric patients weighing at least 14 kg: who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically-suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen with no known or suspected substitutions associated with resistance to bictegravir or tenofovir [see Dosage and Administration (2.4), and Use in Specific Populations (8.1)].

The recommended treatment course for individuals diagnosed with Human Immunodeficiency Virus (HIV) is a complete regimen such as BIKTARVY, which is indicated for adults and pediatric patients weighing at least 14 kg with no antiretroviral treatment history or for those who are virologically-suppressed on a stable antiretroviral regimen.

• Key points:
  • BIKTARVY is a complete regimen for HIV-1 infection treatment.
  • It is indicated for adults and pediatric patients weighing at least 14 kg.
  • Patients should have no antiretroviral treatment history or be virologically-suppressed on a stable antiretroviral regimen.
  • The regimen should have no known or suspected substitutions associated with resistance to bictegravir or tenofovir. 2

From the Research

HIV Protection and Treatment Course

The recommended treatment course for individuals diagnosed with Human Immunodeficiency Virus (HIV) typically involves antiretroviral therapy (ART). The key aspects of HIV treatment are:

• Antiretroviral Therapy (ART): Highly active antiretroviral therapy (HAART) has dramatically changed the course of HIV infection 3, 4.
• Combination Therapy: This therapy involves the use of agents from at least two distinct classes of antivirals, such as a protease inhibitor in combination with two nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTIs), or a non-nucleoside reverse transcriptase inhibitor (NNRTI) in combination with NRTIs 3, 4.
• New Agents and Therapies: New agents, such as integrase strand transfer inhibitors (INSTIs), have been developed and are recommended as first-line treatment for HIV 5.
• Coformulated Fixed-Dose Combinations: Coformulated fixed-dose combinations, such as bictegravir, emtricitabine, and tenofovir alafenamide, are preferred to facilitate adherence 5.
• Short-Cycle Therapy: Short-cycle therapy with bictegravir/emtricitabine/tenofovir alafenamide has been shown to be a safe and effective alternative to the standard daily antiretroviral regimen for individuals living with HIV who are virologically suppressed 6.
• Resistance and Adherence: Treatment-emergent resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) can occur in patients with suboptimal treatment adherence 7.

Key Considerations

Some key considerations for HIV treatment include:

• Adherence: Adherence to antiretroviral therapy is crucial to prevent treatment-emergent resistance and ensure viral suppression.
• Resistance Testing: Genotypic drug resistance testing can be used to identify emergent resistance mutations in patients experiencing virological failure.
• New Therapies and Formulations: New therapies and formulations, such as long-acting antiretroviral drugs, are being developed to improve treatment outcomes and reduce side effects.
• Individualized Treatment: Treatment regimens should be individualized based on patient factors, such as viral load, CD4 cell count, and medication adherence.