The International Antiviral Society – USA Panel published their updated recommendations on antiretroviral drugs (ARVs) for the treatment and prevention of HIV infection. With more than 37 million people living with an HIV infection in the world, and 20 million not receiving an antiretroviral therapy, the new guidelines reiterate that all individuals diagnosed with the infection should initiate treatment as soon as possible, regardless of the CD4 cell count.
Moreover, the guidelines reflect on the substantial advances of the ARVs since the last recommendations were released in 2014, recommending initial regimens of two nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI) for most patients. Further points on preexposure and postexposure prophylaxis are discussed, as well as the pharmacoeconomics of the treatment, especially considering the introduction of less-expensive generic formulations.
In the accompanying editorial on JAMA, Kenneth Mayer and Douglas Krakower consider the guidelines a reflection of a successful 35-year research effort and argue that, “Historians may wonder whether the pace of discovery in the early days of the epidemic could have been accelerated, but no one can doubt the signal accomplishments of biobehavioral research and community engagement in forging a common strategy to deal with this global pandemic, one that continues to pose new challenges.”
