From the Guidelines
The initial treatment regimen for a patient with suspected HIV infection should begin with immediate HIV testing to confirm the diagnosis, followed by the initiation of antiretroviral therapy (ART) with an integrase strand transfer inhibitor (INSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) as soon as possible after diagnosis, ideally within days. The standard first-line ART regimens include bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy) as a single tablet once daily, or dolutegravir (Tivicay) 50mg once daily plus tenofovir/emtricitabine (Truvada or Descovy) once daily, as recommended by the most recent guidelines 1. Before starting treatment, baseline laboratory tests should be performed, including:
- CD4 count
- HIV viral load
- Resistance testing
- Complete blood count
- Comprehensive metabolic panel
- Hepatitis screenings
- Tuberculosis testing These medications work by preventing HIV from replicating and integrating into host cells, thereby reducing viral load and allowing immune system recovery 1. Patients should be counseled about the importance of medication adherence, potential side effects, and the need for regular follow-up appointments to monitor treatment effectiveness and manage any complications. The choice of initial regimen may be influenced by unique patient circumstances, such as concomitant diseases and conditions, potential for pregnancy, or cost considerations 1. Early initiation of ART has been shown to reduce HIV transmission and prevent disease progression, and is therefore recommended for all individuals with HIV infection, regardless of CD4 cell count 1.
From the FDA Drug Label
GENVOYA is indicated as a complete regimen for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 25 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 for at least 6 months with no history of treatment failure and no known substitutions associated with resistance to the individual components of GENVOYA [see Clinical Studies (14)].
The initial treatment regimen for a patient with suspected Human Immunodeficiency Virus (HIV) infection is GENVOYA, which is indicated as a complete regimen for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 25 kg who have no antiretroviral treatment history 2.
- Key points:
- GENVOYA is a complete regimen for HIV-1 infection treatment
- Indicated for adults and pediatric patients weighing at least 25 kg
- For patients with no antiretroviral treatment history or those who are virologically-suppressed on a stable antiretroviral regimen 2
From the Research
Initial Treatment Regimen for Suspected HIV Infection
The initial treatment regimen for a patient with suspected Human Immunodeficiency Virus (HIV) infection typically involves antiretroviral therapy (ART). Key considerations include:
- The use of fixed-dose combination nucleoside reverse-transcriptase inhibitors (NRTIs) with a nonnucleoside reverse-transcriptase inhibitor or a ritonavir-boosted protease inhibitor as initial therapy 3
- The selection of an appropriate NRTI combination, with tenofovir disoproxil fumarate (DF)-emtricitabine being a preferred option over abacavir-lamivudine for patients with high screening HIV-1 RNA levels 3
Treatment Options
Treatment options for suspected HIV infection include:
- Abacavir-lamivudine or tenofovir DF-emtricitabine plus efavirenz or ritonavir-boosted atazanavir 3
- Darunavir/ritonavir (DRV/r) in combination with tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC) 4, 5
- Empiric antiretroviral therapy (ART) in an emergency department setting for patients with suspected acute HIV infection 6
Timing of Treatment Initiation
The timing of ART initiation is crucial, with recommendations for immediate treatment initiation upon diagnosis 7. However, the feasibility of empiric HIV treatment in an emergency department setting has been demonstrated, with a high willingness among patients to begin ART 6.