IDSE Review
Updates to the 2021 Guidelines for ARV Use in Adults and Adolescents With HIV BY ASHLEY HOARE, MS; JESSICA HOARE, MS; AND JULIA GARCIA-DIAZ, MD, MSC, FACP, FIDSA, CPI
T
here were almost 38,000 adults and adolescents diagnosed with HIV infection in the United States and dependent areas in 2018, a decrease compared with 2015.1 The highest rates of diagnoses were reported in the South, the Northeast, followed by the West (Figure). Although almost 80% of these new diagnoses were in men, the number of men diagnosed with HIV in the United States and dependent areas decreased by 10% between 2015 and 2019. Despite the decrease in new diagnoses, the prevalence of HIV in adults and adolescents in the United States increased to more than 1 million in 2019.2 Of those living with HIV, approximately 65% have achieved viral suppression of their HIV infection.3 Achieving viral suppression is the result of careful selection of and adherence to the appropriate treatment. Recent data from a number of ongoing clinical trials have led to several updates to the “Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV” that are important to consider when selecting the optimal treatment.4
Recommended as Initial Regimens for Most People With HIV Four regimens are currently in the category “recommended as initial regimens for most people with HIV” (Table 1).4 Three of these regimens include 1 integrase strand transfer inhibitor (INSTI) in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). The fourth recommended regimen for initial treatment is a combination of 1 INSTI with 1 NRTI. Dolutegravirlamivudine (DTG/3TC; Dovato, ViiV Healthcare). However, DTG/3TC is only recommended for people who have already had genotypic testing for reverse transcriptase; it is not recommended for those with HIV RNA greater than 500,000 copies/mL, nor for patients with hepatitis B virus
INFECTIOUS DISEASE SPECIAL EDITION • SPRING 2022
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