HTB

US HIV Guidelines updated (December 2019)

Simon Collins, HIV i-Base

The latest edition of the US DHSS HIV guidelines is now published online. [1]

Main changes in this edition are summarised at the start of the main document. [2]

Selected key points are listed below.

  • Inclusion of a new section on U=U. This stresses that an undetectable viral load <200 copies/mL with continued high adherence prevents HIV transmission.
  • Restrictions on use of dolutegravir in relation to neural tube defects during pregnancy have been reduced – to be decided on individual risk/benefit.
  • That random testing for pre-ART lipid and glucose can be used instead of previous recommendation for these to be fasted.
  • That ART be routinely started either immediately or as soon as possible after diagnosis.
  • Dolutegravir/lamivudine dual therapy is added to the list of recommended first-line combinations, unless viral load is >500,000 c/mL, HBV coinfection or still waiting for genotypic resistance test results or HBV serology.
  • Bictegravir/FTC/TAF is included as a combination for immediate ART if resistance test results are not available.
  • Updated and expanded section on HIV and older people. This includes awareness of HIV risk, age-related comorbidities, importance of ART, polypharmacy and management of HIV associated neurocognitive disorder (HAND).
  • Option for short course regimen for latent TB.
  • A new sub-section on drug pricing and access in the US.
  • Updated tables on side effects and drug interactions.

References

  1. US Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. 18 December 2019.
    https://aidsinfo.nih.gov/guidelines
  2. What’s new in the guidelines.
    https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/0

Links to other websites are current at date of posting but not maintained.