Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Abstract

ImportanceData on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.ObjectiveTo evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV.Evidence ReviewNew evidence was collected since the previous International Antiviral (formerly AIDS) Society–USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations.FindingsFrom 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic.Conclusion and RelevanceAdvances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

“…Antiretroviral therapy (ART) significantly improves patients’ survival, increasing life expectancy and quality [ 2 , 3 , 4 ]. Furthermore, it plays a relevant role in the prevention of HIV-1 transmission in the population [ 5 , 6 , 7 , 8 ]. However, the emergence of drug resistance mutations (DRM) represents a major threat for the continued control of HIV replication, and consequent potential increase in the transmission of viral strains with DRM [ 9 , 10 ].…”

Dolutegravir Plus Lamivudine Two-Drug Regimen: Safety, Efficacy and Diagnostic Considerations for Its Use in Real-Life Clinical Practice—A Refined Approach in the COVID-19 Era

“…An important aspect to consider with this 2DR is the need to assess the initial VL, and confirm the absence of HBV co-infection. In case the patient is HBV-infected (positive HBsAg and/or HBV-DNA test result), a 3DR-containing TDF or tenofovir alafenamide (TAF) should be used, as these are effective against both viruses [ 2 , 3 , 4 ].…”

“…Integrase strand transfer inhibitor (InSTI)-based cART is a highly potent, cost-effective and safe combination, recommended for treatment of both drug-naïve and treatment-experienced individuals infected with HIV-1 [ 2 , 3 , 4 ]. Among available InSTI, dolutegravir (DTG) is currently the most commonly used option for either initiating or switching cART [ 5 , 6 ].…”

Antiretroviral Drugs Regulate Epigenetic Modification of Cardiac Cells Through Modulation of H3K9 and H3K27 Acetylation

“…In general, patients receive a combination of two or three drugs, such as nucleoside reverse transcriptase inhibitors (lamivudine and abacavir), along with protease inhibitors (ritonavir and atazanavir) (18). Although, in 2020 international antiviral society-USA panel suggest that regimens of three drugs including 2 nucleoside reverse transcriptase inhibitor and an integrase inhibitor can be useful to suppress the viral replication (19), some of the developing nations continuously using the old regime of first line NRTIbased cocktail along with protease inhibitors (20)(21)(22). Chronic administration of multiple drugs may lead to CVD and heart failure in HIV patients through cellular and molecular modification in cardiomyocytes, which leads to modulation of pathological gene expression (5,23,24).…”