Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice.
Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.
A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.
Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential.
Conclusions and Relevance
Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.
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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.
Corresponding Author: Rajesh T. Gandhi, MD, Cox 548, Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (RGANDHI@mgh.harvard.edu).
Accepted for Publication: November 13, 2022.
Published Online: December 1, 2022. doi:10.1001/jama.2022.22246
Author Contributions: Dr Gandhi 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: Gandhi, Bedimo, Hoy, Landovitz, Eaton, Lehmann, Sax, Thompson, Benson, Buchbinder, del Rio, Eron, Günthard, Jacobsen, Saag.
Acquisition, analysis, or interpretation of data: Gandhi, Bedimo, Hoy, Landovitz, Smith, Eaton, Lehmann, Springer, Thompson, Benson, Buchbinder, del Rio, Eron, Günthard, Molina, Saag.
Drafting of the manuscript: Gandhi, Bedimo, Hoy, Landovitz, Smith, Eaton, Lehmann, Springer, Sax, Thompson, Benson, del Rio, Jacobsen, Saag.
Critical revision of the manuscript for important intellectual content: Gandhi, Bedimo, Hoy, Landovitz, Smith, Eaton, Lehmann, Springer, Thompson, Benson, Buchbinder, del Rio, Eron, Günthard, Molina, Saag.
Obtained funding: Jacobsen.
Administrative, technical, or material support: Landovitz, Smith, Eaton, Lehmann, Jacobsen, Saag.
Supervision: Gandhi, Sax, Benson, Jacobsen, Saag.
Conflict of Interest Disclosures: Dr Gandhi reported receiving grants from the National Institutes of Health (NIH). Dr Bedimo reported receiving grants from Merck and ViiV Healthcare and serving on the scientific advisory board of Merck, ViiV Healthcare, Gilead Sciences, Theratechnologies, and Janssen Scientific. Dr Hoy reported serving on the advisory board of ViiV Healthcare and Gilead Sciences. Dr Landovitz reported serving on the scientific advisory board of Gilead Sciences and Merck; receiving consulting fees from Cepheid; and receiving grants from the NIH and ViiV Healthcare. Dr Smith reported receiving grants from the NIH San Diego Center for AIDS Research and receiving personal fees from Linear Therapies, Model Medicines, Pharma Holdings, Bayer Pharmaceuticals, and Evidera. Dr Eaton reported receiving grants paid to her institution from NIH and Bristol Myers Squibb and receiving consulting fees from Gilead Sciences. Dr Lehmann reported receiving personal fees from VIIV Healthcare, Gilead, Pfizer, Janssen, Novartis, BioNTech, and Merck Sharp & Dohme and receiving grants from the German Center of Infection Research and the German Ministry of Research. Dr Springer reported receiving grants from the National Institute on Drug Abuse, National Center for Advancing Translational Science, and Veterans Affairs Cooperative Studies Program; receiving consulting fees from Alkermes Inc; and receiving in-kind drug donation from Alkermes Inc (Vivitrol) and Indivior (Sublocade) for NIH-sponsored research. Dr Sax reported receiving grants from Gilead and ViiV and receiving personal fees from Gilead, Janssen, Merck, and ViiV. Dr Thompson reported receiving research funding to the AIDS Research Consortium of Atlanta from Bristol Myers Squibb, Cepheid Inc, Cytodyne Inc, Frontier Biotechnologies, Gilead Sciences, GlaxoSmithKline, Merck Sharp & Dohme, and ViiV and serving as chair of an independent data monitoring committee for Excision Biotherapeutics. Dr Benson reported receiving grants from NIH/National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Mental Health; receiving grants to her institution from Fogarty, Gilead, and DNAe; receiving lecture/symposia honoraria from International Antiviral Society–USA; serving as deputy editor of Clinical Infectious Diseases; and receiving consulting fees from NDA Partners. Dr Buchbinder reported receiving grants from Gilead Sciences and ViiV Healthcare. Dr del Rio reported receiving grants from the NIH/NIAID Emory Center for AIDS Research and receiving consulting fees from Resverlogix. Dr Eron reported receiving personal fees from Merck, ViiV Healthcare, and Gilead Sciences and receiving grants from ViiV Healthcare, Gilead Sciences, and Janssen. Dr Günthard reported receiving grants from the Swiss National Science Foundation, NIH, Yvonne Jacob Foundation, Gilead, the Swiss HIV Cohort Study, and advisory board, consulting, and data and safety monitoring board fees from Merck, Gilead Sciences, ViiV Healthcare, GlaxoSmithKline, Janssen, Johnson & Johnson, and Novartis. Dr Molina reported receiving grants from Gilead and serving on the advisory board for Gilead, Merck, and ViiV. Dr Saag reported receiving grants to his institution from ViiV Healthcare and Gilead Sciences and receiving consulting fees from TFF Pharmaceuticals and American Gene Technologies. No other disclosures were reported.
Funding/Support: This work was 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, vetted and selected the panel members, and provided administrative support and oversight. The panel had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Paul A. Volberding, MD, who initiated the volunteer panel in 1995 and helped guide the committee for 25 years. We also thank Michelle Valderama, BS, production and web manager from the IAS-USA, for assistance in managing the manuscript versions; Sherry Wu, BS, for administrative support; and Kimberly R. Powell, MIS, a research impact informationist from Emory University for conducting the PubMed and Embase literature searches. Dr Volberding and Ms Powell received no financial compensation from the sponsor for this article. Ms Valderama and Ms Wu are salaried employees of the sponsor of this article.
Additional Information: This article is dedicated to the memory of Scott M. Hammer, MD, founding member of the panel and former panel chair.
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