[Skip to Content]
[Skip to Content Landing]

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2020 Recommendations of the International Antiviral Society–USA Panel

Educational Objective
To review updated recommendations regarding the use of antiretroviral therapy for treatment and prevention of HIV infection.
1 Credit CME

Importance  Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.

Objective  To 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 Review  New 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.

Findings  From 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 Relevance  Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Michael S. Saag, MD, School of Medicine, University of Alabama at Birmingham, 845 19th St S, BBRB 256, Birmingham, AL 35294 (msaag@uabmc.edu).

Accepted for Publication: September 2, 2020.

Published Online: October 14, 2020. doi:10.1001/jama.2020.17025

Author Contributions: Dr Saag had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Saag, Gandhi, Hoy, Landovitz, Thompson, Sax, Smith, Benson, del Rio, Eron, Fätkenheuer, Günthard, Jacobsen, Volberding.

Acquisition, analysis, or interpretation of data: Saag, Hoy, Landovitz, Thompson, Sax, Smith, Benson, Buchbinder, del Rio, Fätkenheuer, Günthard, Molina, Volberding.

Drafting of the manuscript: Saag, Gandhi, Hoy, Landovitz, Thompson, Sax, Smith, Benson, del Rio, Fätkenheuer, Jacobsen, Volberding.

Critical revision of the manuscript for important intellectual content: Saag, Hoy, Landovitz, Thompson, Sax, Smith, Benson, Buchbinder, Eron, Fätkenheuer, Günthard, Molina.

Statistical analysis: Fätkenheuer.

Obtained funding: Jacobsen.

Administrative, technical, or material support: Saag, Sax, Smith, Fätkenheuer, Jacobsen, Volberding.

Supervision: Saag, Landovitz, Smith, Benson, Fätkenheuer, Molina, Jacobsen.

Conflict of Interest Disclosures: Drs Saag reported receiving grants paid to his institution from Gilead Sciences and ViiV Healthcare. Dr Gandhi reported serving on advisory boards and receiving personal fees from Gilead, Merck, and Theratechnologies. Dr Hoy reported receiving personal fees paid to her institution from Gilead Sciences, ViiV Healthcare, and Merck, Sharp & Dohme Australia. Dr Landovitz reported reported serving on advisory boards and receiving personal fees and travel reimbursement from Gilead Sciences and Merck; and receiving personal fees and travel reimbursement from Roche. Dr Thompson reported receiving research support paid to the AIDS Research Consortium of Atlanta for the conduct of clinical trials from Bristol-Myers Squibb, Cepheid Inc, Cytodyn Inc, Gilead Sciences, GlaxoSmithKline, Merck Sharp & Dohme, Frontier Biotechnology, and ViiV Healthcare. Dr Sax reported serving on advisory boards and receiving grants and personal fees from Gilead and ViiV; and serving on advisory boards and receiving personal fees from Janssen and Merck. Dr Smith reported receiving grants from the National Institutes of Health; and serving as a consultant and receiving personal fees from Arena Pharma, Bayer, and AIDS Healthcare Foundation; and serving on advisory boards and receiving personal fees from FluxErgy. Dr Benson reported receiving grants paid to her institution from the National Institutes of Health and Gilead; and receiving personal fees from ViiV Healthcare, GlaxoSmithKline, IDSA, and IAS-USA. Dr Buchbinder reported receiving nonfinancial support (study drug) from Gilead Sciences. Dr del Rio reported receiving grants from the National Institutes of Health. Dr Eron reported receiving grants and personal fees from ViiV Healthcare, Gilead Sciences, and Janssen; and receiving personal fees from Merck. Dr Fätkenheuer reported receiving grants and personal fees from Janssen Cilag; receiving grants and travel reimbursement from Gilead; serving on advisory boards and receiving grants from Merck Sharp & Dohme; and serving on advisory boards and receiving personal fees from ViiV Healthcare. Dr Günthard reported receiving grants from the Swiss National Science Foundation, the Swiss HIV Cohort Study, the National Institutes of Health, Gilead Sciences, the Yvonne Jacob Foundation; and serving as a consultant and receiving personal fees from Merck, Gilead Sciences, and ViiV Healthcare. Dr Molina reported serving on advisory boards and receiving personal fees from Gilead, Merck, and ViiV Healthcare. Dr Volberding reported receiving personal fees from Merck and Gilead. No other disclosures were reported.

Funding/Support: The work is sponsored and funded by the International Antiviral Society–USA (IAS-USA). IAS-USA is a mission-based, nonmembership, 501(c)(3) not-for-profit organization. No private sector or government funding was used to support the effort. Panel members are not compensated for participation in the effort.

Role of the Funder/Sponsor: The IAS-USA determined the need to update recommendations, selected the panel members, and provided administrative support and oversight. The panel designs and conducts the work; collects, manages, analyzes, and interprets the data; and prepares, reviews, and approves the manuscript.

Additional Contributions: We thank Michelle Valderama, BS (production and web manager from the IAS-USA), for assistance in managing the manuscript versions, and Kimberly R. Powell, MIS (systematic review methodologist from Emory University), for conducting the PubMed and EMBASE literature searches. Neither received additional compensation beyond their normal salaries. We dedicate this article to the memory of Timothy Ray Brown.

Saag  MS , Benson  CA , Gandhi  RT ,  et al.  Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the International Antiviral Society–USA panel.   JAMA. 2018;320(4):379-396. doi:10.1001/jama.2018.8431PubMedGoogle ScholarCrossref
Canadian Task Force on the Periodic Health Examination.  The periodic health examination.   Can Med Assoc J. 1979;121(9):1193-1254.PubMedGoogle Scholar
Mateo-Urdiales  A , Johnson  S , Smith  R , Nachega  JB , Eshun-Wilson  I .  Rapid initiation of antiretroviral therapy for people living with HIV.   Cochrane Database Syst Rev. 2019;6:CD012962. doi:10.1002/14651858.CD012962.pub2PubMedGoogle Scholar
Amstutz  A , Brown  JA , Ringera  I ,  et al.  Engagement in care, viral suppression, drug resistance and reasons for non-engagement after home-based same-day ART initiation in Lesotho: a two-year follow-up of the CASCADE trial.   Clin Infec Dis. doi:10.1093/cid/ciz1126 Published online November 29, 2019. PubMedGoogle Scholar
Coffey  S , Bacchetti  P , Sachdev  D ,  et al.  RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population.   AIDS. 2019;33(5):825-832. doi:10.1097/QAD.0000000000002124PubMedGoogle ScholarCrossref
Seybolt  L , Conner  K , Butler  I , VanSickels  N , Halperin  J .  Rapid start lead to sustained viral suppression in young people in the South [Abstract 1073] in special issue: Abstracts From the 2020 Conference on Retroviruses and Opportunistic Infections.   Top Antivir Med. 2020;28(1):407.Google Scholar
Cuzin  L , Cotte  L , Delpierre  C ,  et al; Dat’AIDS study group.  Too fast to stay on track? shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat’AIDS cohort.   PLoS One. 2019;14(9):e0222067. doi:10.1371/journal.pone.0222067PubMedGoogle Scholar
Colasanti  J , Sumitani  J , Mehta  CC ,  et al.  Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the Southern United States.   Open Forum Infect Dis. 2018;5(6):ofy104. doi:10.1093/ofid/ofy104PubMedGoogle Scholar
AIDS Info. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Accessed May 18, 2020. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection/whats-new-guidelines
Cahn  P , Madero  JS , Arribas  JR ,  et al; GEMINI study team.  Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials.   Lancet. 2019;393(10167):143-155. doi:10.1016/S0140-6736(18)32462-0PubMedGoogle ScholarCrossref
Zash  R , Holmes  L , Diseko  M ,  et al.  Neural-tube defects and antiretroviral treatment regimens in Botswana.   N Engl J Med. 2019;381(9):827-840. doi:10.1056/NEJMoa1905230PubMedGoogle ScholarCrossref
Zash  R . Update on neural tube defects with antiretroviral exposure in the Tsepamo study, Botswana. Poster presented at: 23rd International AIDS Conference; July 6-10, 2020; virtual.
Chinula  L , Brummel  SS , Ziemba  L ,  et al.  Safety and efficacy of DTG vs EFV and TDF vs TAF in pregnancy: IMPAACT 2010 trial [Abstract 130] in special issue: Abstracts From the 2020 Conference on Retroviruses and Opportunistic Infections.   Top Antivir Med. 2020;28(1):42-43.Google Scholar
Bakal  DR , Coelho  LE , Luz  PM ,  et al.  Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors.   J Antimicrob Chemother. 2018;73(8):2177-2185. doi:10.1093/jac/dky145PubMedGoogle ScholarCrossref
Bares  SH , Smeaton  LM , Xu  A , Godfrey  C , McComsey  GA .  HIV-infected women gain more weight than HIV-infected men following the initiation of antiretroviral therapy.   J Womens Health (Larchmt). 2018;27(9):1162-1169. doi:10.1089/jwh.2017.6717PubMedGoogle ScholarCrossref
Sax  PE , Erlandson  KM , Lake  JE ,  et al.  Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials.   Clin Infect Dis. 2020;71(6):1379-1389. doi:10.1093/cid/ciz999PubMedGoogle ScholarCrossref
Kouanfack  C , Mpoudi-Etame  M , Omgba Bassega  P ,  et al; NAMSAL ANRS 12313 study group.  Dolutegravir-based or low-dose efavirenz-based regimen for the treatment of HIV-1.   N Engl J Med. 2019;381(9):816-826. doi:10.1056/NEJMoa1904340PubMedGoogle ScholarCrossref
Venter  WDF , Moorhouse  M , Sokhela  S ,  et al.  Dolutegravir plus two different prodrugs of tenofovir to treat HIV.   N Engl J Med. 2019;381(9):803-815. doi:10.1056/NEJMoa1902824PubMedGoogle ScholarCrossref
Bhagwat  P , Ofotokun  I , McComsey  GA ,  et al.  Changes in waist circumference in HIV-infected individuals initiating a raltegravir or protease inhibitor regimen: effects of sex and race.   Open Forum Infect Dis. 2018;5(11):ofy201. doi:10.1093/ofid/ofy201PubMedGoogle Scholar
Mayer  KH , Molina  JM , Thompson  MA ,  et al.  Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial.   Lancet. 2020;396(10246):239-254. doi:10.1016/S0140-6736(20)31065-5PubMedGoogle ScholarCrossref
Dooley  KE , Kaplan  R , Mwelase  N ,  et al; International Study of Patients with HIV on Rifampicin ING study group.  Dolutegravir-based antiretroviral therapy for patients coinfected with tuberculosis and human immunodeficiency virus: a multicenter, noncomparative, open-label, randomized trial.   Clin Infect Dis. 2020;70(4):549-556.PubMedGoogle Scholar
Cerrone  M , Alfarisi  O , Neary  M ,  et al.  Rifampicin effect on intracellular and plasma pharmacokinetics of tenofovir alafenamide.   J Antimicrob Chemother. 2019;74(6):1670-1678. doi:10.1093/jac/dkz068PubMedGoogle Scholar
Dooley  KE , Savic  R , Gupte  A ,  et al; DOLPHIN study team.  Once-weekly rifapentine and isoniazid for tuberculosis prevention in patients with HIV taking dolutegravir-based antiretroviral therapy: a phase 1/2 trial.   Lancet HIV. 2020;7(6):e401-e409. doi:10.1016/S2352-3018(20)30032-1PubMedGoogle Scholar
Eron  JJ , Orkin  C , Cunningham  D ,  et al; EMERALD study group.  Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1.   Antiviral Res. 2019;170:104543. doi:10.1016/j.antiviral.2019.104543PubMedGoogle Scholar
van Wyk  J , Ajana  F , Bisshop  F ,  et al.  Efficacy and safety of switching to dolutegravir/lamivudine fixed-dose two-drug regimen versus continuing a tenofovir alafenamide-based three- or four-drug regimen for maintenance of virologic suppression in adults with HIV-1: phase 3, randomized, non-inferiority TANGO Study.   Clin Infect Dis. Published online January 6, 2020. doi:10.1093/cid/ci1243Google Scholar
Aboud  M , Orkin  C , Podzamczer  D ,  et al.  Efficacy and safety of dolutegravir-rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies.   Lancet HIV. 2019;6(9):e576-e587. doi:10.1016/S2352-3018(19)30149-3PubMedGoogle Scholar
Swindells  S , Andrade-Villanueva  JF , Richmond  GJ ,  et al.  Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression.   N Engl J Med. 2020;382(12):1112-1123. doi:10.1056/NEJMoa1904398PubMedGoogle Scholar
Orkin  C , Arasteh  K , Górgolas Hernández-Mora  M ,  et al.  Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection.   N Engl J Med. 2020;382(12):1124-1135. doi:10.1056/NEJMoa1909512PubMedGoogle Scholar
Overton  ET , Richmond  GJ , Rizzardini  G ,  et al.  Cabotegravir + rilpivirine every 2 months is noninferior to monthly: ATLAS-2M STUDY [Abstract 34] in special issue: Abstracts From the 2020 Conference on Retroviruses and Opportunistic Infections.   Top Antivir Med. 2020;28(1):11.Google Scholar
Olearo  F , Nguyen  H , Bonnet  F ,  et al.  Impact of the M184V/I mutation on the efficacy of abacavir/lamivudine/dolutegravir therapy in HIV treatment-experienced patients.   Open Forum Infect Dis. 2019;6(10):ofz330. doi:10.1093/ofid/ofz330PubMedGoogle Scholar
Andreatta  K , Willkom  M , Martin  R ,  et al.  Switching to bictegravir/emtricitabine/tenofovir alafenamide maintained HIV-1 RNA suppression in participants with archived antiretroviral resistance including M184V/I.   J Antimicrob Chemother. 2019;74(12):3555-3564. doi:10.1093/jac/dkz347PubMedGoogle Scholar
Acosta  RK , Willkom  M , Martin  R ,  et al.  Resistance analysis of bictegravir-emtricitabine-tenofovir alafenamide in HIV-1 treatment-naive patients through 48 weeks.   Antimicrob Agents Chemother. 2019;63(5):1-3. doi:10.1128/AAC.02533-18PubMedGoogle Scholar
Althoff  KN , Gebo  KA , Moore  RD ,  et al; North American AIDS Cohort Collaboration on Research and Design.  Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies.   Lancet HIV. 2019;6(2):e93-e104. doi:10.1016/S2352-3018(18)30295-9PubMedGoogle Scholar
Surial  B , Ledergerber  B , Calmy  A ,  et al; Swiss HIV Cohort study.  Changes in renal function after switching from TDF to TAF in HIV-infected individuals: a prospective cohort study.   J Infect Dis. 2020;222(4):637-645. doi:10.1093/infdis/jiaa125PubMedGoogle Scholar
Hoy  JF , Richardson  R , Ebeling  PR ,  et al; ZEST study investigators.  Zoledronic acid is superior to tenofovir disoproxil fumarate-switching for low bone mineral density in adults with HIV.   AIDS. 2018;32(14):1967-1975.PubMedGoogle Scholar
Schafer  JJ , Sassa  KN , O’Connor  JR , Shimada  A , Keith  SW , DeSimone  JA .  Changes in body mass index and atherosclerotic disease risk score after switching from tenofovir disoproxil fumarate to tenofovir alafenamide.   Open Forum Infect Dis. 2019;6(10):ofz414. doi:10.1093/ofid/ofz414PubMedGoogle Scholar
Mallon  P , Brunet  L , Hsu  R , Fusco  J , Mounzer  K , Prajapati  G . Weight gain before and after switch from TDF to TAF. Poster presented at: 23rd International AIDS Conference; July 6-10, 2020; virtual.
Bajema  KL , Nance  RM , Delaney  JAC ,  et al. Changing rates of heavily treatment experienced persons with HIV in the United States, 2000-2017. Poster presented at: 10th IAS Conference on HIV Science; July 21-24, 2019; Mexico City, Mexico.
Aboud  M , Kaplan  R , Lombaard  J ,  et al.  Dolutegravir versus ritonavir-boosted lopinavir both with dual nucleoside reverse transcriptase inhibitor therapy in adults with HIV-1 infection in whom first-line therapy has failed (DAWNING): an open-label, non-inferiority, phase 3b trial.   Lancet Infect Dis. 2019;19:253-264.Google Scholar
Gandhi  RT , Tashima  KT , Smeaton  LM ,  et al.  Long-term outcomes in a large randomized trial of HIV-1 salvage therapy: 96-week results of AIDS Clinical Trials Group A5241 (OPTIONS).   J Infect Dis. 2020;221(9):1407-1415. doi:10.1093/infdis/jiz281PubMedGoogle Scholar
Emu  B , Fessel  J , Schrader  S ,  et al.  Phase 3 study of ibalizumab for multidrug-resistant HIV-1.   N Engl J Med. 2018;379(7):645-654. doi:10.1056/NEJMoa1711460PubMedGoogle Scholar
Emu  B , DeJesus  E , Berhe  M ,  et al.  Ibalizumab efficacy and safety through 48 weeks of treatment: results of an expanded access protocol (TMB-311).   Cre Open Forum Infect Dis. 2020;6(suppl 2):S303. doi:10.1093/ofid/ofz360.729Google Scholar
Millham  LRI , Scott  JA , Sax  PE ,  et al.  Clinical and economic impact of ibalizumab for people with multidrug-resistant HIV in the United States.   J Acquir Immune Defic Syndr. 2020;83(2):148-156. doi:10.1097/QAI.0000000000002241PubMedGoogle Scholar
Kozal  M , Aberg  J , Pialoux  G ,  et al; BRIGHTE trial team.  Fostemsavir in adults with multidrug-resistant HIV-1 infection.   N Engl J Med. 2020;382(13):1232-1243. doi:10.1056/NEJMoa1902493PubMedGoogle Scholar
Soulie  C , Santoro  MM , Storto  A ,  et al.  Prevalence of doravirine-associated resistance mutations in HIV-1-infected antiretroviral-experienced patients from two large databases in France and Italy.   J Antimicrob Chemother. 2020;75(4):1026-1030. doi:10.1093/jac/dkz553PubMedGoogle Scholar
Sanford Guide. Sanford guide collection. Accessed August 25, 2020. https://www.sanfordguide.com/products/digital-subscriptions/collection/
US Centers for Disease and Control and Prevention. Vaccines and immunizations. Accessed September 22, 2020. https://www.cdc.gov/vaccines/index.html
US Centers for Disease and Control and Prevention. ACIP vaccine recommendations and guidelines. Accessed August 25, 2020. https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
DiNenno  EA , Prejean  J , Delaney  KP ,  et al.  Evaluating the evidence for more frequent than annual HIV screening of gay, bisexual, and other men who have sex with men in the United States: results from a systematic review and CDC expert consultation.   Public Health Rep. 2018;133(1):3-21. doi:10.1177/0033354917738769PubMedGoogle Scholar
Manak  MM , Jagodzinski  LL , Shutt  A ,  et al; RV254/SEARCH010 and the RV217 study teams.  Decreased seroreactivity in individuals initiating antiretroviral therapy during acute HIV infection.   J Clin Microbiol. 2019;57(10):e00757-e19. doi:10.1128/JCM.00757-19PubMedGoogle Scholar
Pereira  IO , Pascom  A , Mosimann  G ,  et al.  Post-exposure prophylaxis following consented sexual exposure: impact of national recommendations on user profile, drug regimens and estimates of averted HIV infections.   HIV Med. 2020;21(4):240-245. doi:10.1111/hiv.12825PubMedGoogle Scholar
Alghamdi  A , Hempel  A , Heendeniya  A , Clifford-Rashotte  M , Tan  DHS , Bogoch  II .  HIV post-exposure prophylaxis-in-pocket (“PIP”): long-term follow-up of individuals with low-frequency, high-risk HIV exposures.   AIDS. doi:10.1097/QAD.0000000000002441 Published online November 14, 2019. PubMedGoogle Scholar
Hyle  EP , Scott  JA , Sax  PE ,  et al.  Clinical impact and cost-effectiveness of genotype testing at human immunodeficiency virus diagnosis in the United States.   Clin Infect Dis. 2020;70(7):1353-1363. doi:10.1093/cid/ciz372PubMedGoogle Scholar
Alvarez  M , Casas  P , de Salazar  A ,  et al; CoRIS.  Surveillance of transmitted drug resistance to integrase inhibitors in Spain: implications for clinical practice.   J Antimicrob Chemother. 2019;74(6):1693-1700. doi:10.1093/jac/dkz067PubMedGoogle Scholar
Günthard  HF , Calvez  V , Paredes  R ,  et al.  Human immunodeficiency virus drug resistance: 2018 recommendations of the International Antiviral Society-USA Panel.   Clin Infect Dis. 2019;68(2):177-187. doi:10.1093/cid/ciy463PubMedGoogle Scholar
Zhu  J , Rozada  I , David  J ,  et al.  The potential impact of initiating antiretroviral therapy with integrase inhibitors on HIV transmission risk in British Columbia, Canada.   EClinicalMedicine. 2019;13:101-111. doi:10.1016/j.eclinm.2019.07.001PubMedGoogle Scholar
Liu  CM , Prodger  J , Tobian  A ,  et al.  Abundance of penile anaerobes, IL-8, and the risk of HIV acquisition, Rakai, Uganda [Abstract 87] in special issue: Abstracts From the 2017 Conference on Retroviruses and Opportunistic Infections.   Top Antivir Med. 2017;27(suppl 1):35s.Google Scholar
Nwokolo  N , Hill  A , McOwan  A , Pozniak  A .  Rapidly declining HIV infection in MSM in central London.   Lancet HIV. 2017;4(11):e482-e483. doi:10.1016/S2352-3018(17)30181-9PubMedGoogle Scholar
Grulich  AE , Guy  R , Amin  J ,  et al; Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) research group.  Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study.   Lancet HIV. 2018;5(11):e629-e637. doi:10.1016/S2352-3018(18)30215-7PubMedGoogle Scholar
World Health Organization. What's the 2+1+1? event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: update to WHO's recommendation on oral PrEP. Accessed March 22, 2020. https://apps.who.int/iris/bitstream/handle/10665/325955/WHO-CDS-HIV-19.8-eng.pdf?ua=1
Landovitz  RJ , Donnell  D , Clement  M ,  et al. HPTN 083 interim results: pre-exposure prophylaxis containing long-acting injectable cabotegravir is safe and highly effective for cisgender men and transgender women who have sex with men. Poster presented at: 23rd International AIDS Conference; July 6-10, 2020; virtual.
Krakower  D . Impact of COVID-19 on HIV pre-exposure prophylaxis care at a Boston community health center. Poster presented at: 23rd International AIDS Conference; July 6-10, 2020; virtual.
Cardo  DM , Culver  DH , Ciesielski  CA ,  et al; Centers for Disease Control and Prevention Needlestick Surveillance Group.  A case-control study of HIV seroconversion in health care workers after percutaneous exposure.   N Engl J Med. 1997;337(21):1485-1490.Google Scholar
Yager  JL , Anderson  PL .  Pharmacology and drug interactions with HIV PrEP in transgender persons receiving gender affirming hormone therapy.   Expert Opin Drug Metab Toxicol. 2020;16(6):463-474. doi:10.1080/17425255.2020.1752662PubMedGoogle Scholar
AETC National Coordinating Resource Center. National clinician consultation center. Accessed May 16, 2020. https://aidsetc.org/aetc-program/national-clinician-consulation-center
US Centers for Disease and Control and Prevention. HIV surveillance report, 2018 (preliminary). Accessed March 22, 2020. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
UNAIDS. UNAIDS data 2019. Accessed March 22, 2020. http://aidsinfo.unaids.org/
Swiss HIV Cohort Study. Swiss HIV Cohort Study current status: age distribution of active patients by year, in the SHCS 1992-2018. Accessed August 24, 2020. http://www.shcs.ch/232-current-status
Autenrieth  CS , Beck  EJ , Stelzle  D , Mallouris  C , Mahy  M , Ghys  P .  Global and regional trends of people living with HIV aged 50 and over: estimates and projections for 2000-2020.   PLoS One. 2018;13(11):e0207005. doi:10.1371/journal.pone.0207005PubMedGoogle Scholar
Marcus  JL , Leyden  WA , Alexeeff  SE ,  et al.  Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000-2016.   JAMA Netw Open. 2020;3(6):e207954.Google Scholar
Blanco  JR , Jarrín  I , Vallejo  M ,  et al; CoRIS.  Definition of advanced age in HIV infection: looking for an age cut-off.   AIDS Res Hum Retroviruses. 2012;28(9):1000-1006. doi:10.1089/aid.2011.0377PubMedGoogle Scholar
Guaraldi  G , Malagoli  A , Calcagno  A ,  et al.  The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65-74 years and more than 75 years.   BMC Geriatr. 2018;18(1):99. doi:10.1186/s12877-018-0789-0PubMedGoogle Scholar
Courlet  P , Stader  F , Guidi  M ,  et al; Swiss HIV Cohort Study.  Pharmacokinetic profiles of boosted darunavir, dolutegravir and lamivudine in aging people living with HIV.   AIDS. 2020;34(1):103-108. doi:10.1097/QAD.0000000000002372PubMedGoogle Scholar
Edelman  EJ , Rentsch  CT , Justice  AC .  Polypharmacy in HIV: recent insights and future directions.   Curr Opin HIV AIDS. 2020;15(2):126-133. doi:10.1097/COH.0000000000000608PubMedGoogle Scholar
Verheij  E , Kirk  GD , Wit  FW ,  et al; AGEhIV Cohort.  Frailty is associated with mortality and incident comorbidity among middle-aged human immunodeficiency virus (HIV)-positive and HIV-negative participants.   J Infect Dis. 2020;222(6):919-928. doi:10.1093/infdis/jiaa010PubMedGoogle Scholar
Hawkins  KL , Zhang  L , Ng  DK ,  et al.  Abdominal obesity, sarcopenia, and osteoporosis are associated with frailty in men living with and without HIV.   AIDS. 2018;32(10):1257-1266. doi:10.1097/QAD.0000000000001829PubMedGoogle Scholar
Fatukasi  TV , Edmonds  A , Gustafson  DR ,  et al.  Prevalence and 1-year incidence of frailty among women with and without HIV in the Women’s Interagency HIV Study.   AIDS. 2019;33(2):357-359. doi:10.1097/QAD.0000000000002047PubMedGoogle Scholar
Hosaka  KRJ , Greene  M , Premeaux  TA ,  et al.  Geriatric syndromes in older adults living with HIV and cognitive impairment.   J Am Geriatr Soc. 2019;67(9):1913-1916. doi:10.1111/jgs.16034PubMedGoogle Scholar
Dent  E , Martin  FC , Bergman  H , Woo  J , Romero-Ortuno  R , Walston  JD .  Management of frailty: opportunities, challenges, and future directions.   Lancet. 2019;394(10206):1376-1386. doi:10.1016/S0140-6736(19)31785-4PubMedGoogle Scholar
Pritchard  JM , Kennedy  CC , Karampatos  S ,  et al.  Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic.   BMC Geriatr. 2017;17(1):264. doi:10.1186/s12877-017-0623-0PubMedGoogle Scholar
Makinson  A , Dubois  J , Eymard-Duvernay  S ,  et al.  Increased prevalence of neurocognitive impairment in aging people living with human immunodeficiency virus: the ANRS EP58 HAND 55-70 study.   Clin Infect Dis. 2020;70(12):2641-2648. doi:10.1093/cid/ciz670PubMedGoogle Scholar
Harris  M , Brouillette  MJ , Mayo  N ,  et al. Associations of loneliness with cognitive function and quality of life (QoL) among older HIV+ adults. Presented at: 9th International Workshop on HIV and Aging; September 13-14, 2018; New York, NY.
Greysen  SR , Horwitz  LI , Covinsky  KE , Gordon  K , Ohl  ME , Justice  AC .  Does social isolation predict hospitalization and mortality among HIV+ and uninfected older veterans?   J Am Geriatr Soc. 2013;61(9):1456-1463. doi:10.1111/jgs.12410PubMedGoogle Scholar
Nguyen  A , Seal  D . Effect of social networks on purpose in life, depression, and physical function among older adults living with HIV. Poster presented at: American Public Health Association Annual Meeting and Expo; November 2-6, 2019; Philadelphia, PA.
Logie  CH , Wang  Y , Lacombe-Duncan  A ,  et al.  HIV-related stigma, racial discrimination, and gender discrimination: pathways to physical and mental health-related quality of life among a national cohort of women living with HIV.   Prev Med. 2018;107:36-44. doi:10.1016/j.ypmed.2017.12.018PubMedGoogle Scholar
Lam  A , Mayo  NE , Scott  S , Brouillette  MJ , Fellows  LK .  HIV-related stigma affects cognition in older men living with HIV.   J Acquir Immune Defic Syndr. 2019;80(2):198-204. doi:10.1097/QAI.0000000000001898PubMedGoogle Scholar
McCann  NC , Horn  TH , Hyle  EP , Walensky  RP .  HIV antiretroviral therapy costs in the United States, 2012-2018.   JAMA Intern Med. 2020;180(4):601-603. doi:10.1001/jamainternmed.2019.7108PubMedGoogle Scholar
Roberts  DA , Tan  N , Limaye  N , Irungu  E , Barnabas  RV .  Cost of differentiated HIV antiretroviral therapy delivery strategies in Sub-Saharan Africa: a systematic review.   J Acquir Immune Defic Syndr. 2019;82(suppl 3):S339-S347. doi:10.1097/QAI.0000000000002195PubMedGoogle Scholar
Beer  L , Tie  Y , Weiser  J , Shouse  RL .  Nonadherence to any prescribed medication due to costs among adults with HIV infection—United States, 2016-2017.   MMWR Morb Mortal Wkly Rep. 2019;68(49):1129-1133. doi:10.15585/mmwr.mm6849a1PubMedGoogle Scholar
Maciejewski  ML , Farley  JF , Parker  J , Wansink  D .  Copayment reductions generate greater medication adherence in targeted patients.   Health Aff (Millwood). 2010;29(11):2002-2008. doi:10.1377/hlthaff.2010.0571PubMedGoogle Scholar
Fauci  AS , Marston  HD .  Ending the HIV-AIDS pandemic—follow the science.   N Engl J Med. 2015;373(23):2197-2199. doi:10.1056/NEJMp1502020PubMedGoogle Scholar
UNAIDS. Communities at the centre: global AIDS update 2019. Accessed April 16, 2020. https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf
Havlir  D , Lockman  S , Ayles  H ,  et al; (Universal Test, Treat Trials) UT3 Consortium.  What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?   J Int AIDS Soc. 2020;23(2):e25455. doi:10.1002/jia2.25455PubMedGoogle Scholar
Marsh  K , Eaton  JW , Mahy  M ,  et al.  Global, regional and country-level 90-90-90 estimates for 2018: assessing progress towards the 2020 target.   AIDS. 2019;33(suppl 3):S213-S226. doi:10.1097/QAD.0000000000002355PubMedGoogle Scholar
Del Rio  C .  Editorial: can we end HIV as a public health problem globally? progress towards achieving the UNAIDS 90-90-90 goals.   Curr Opin HIV AIDS. 2019;14(6):439-441. doi:10.1097/COH.0000000000000592PubMedGoogle Scholar
Fauci  AS , Redfield  RR , Sigounas  G , Weahkee  MD , Giroir  BP .  Ending the HIV epidemic: a plan for the United States.   JAMA. 2019;321(9):844-845. doi:10.1001/jama.2019.1343PubMedGoogle Scholar
Infectious Diseases Society of America. COVID-19 resource center. Accessed May 18, 2020. https://www.idsociety.org/covid-19-real-time-learning-network/
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.