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.


  1. US Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. 18 December 2019.
  2. What’s new in the guidelines.

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