US HIV Guidelines updated (December 2019)
29 January 2020. Related: Guidelines.
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
- US Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. 18 December 2019.
https://clinicalinfo.hiv.gov/en/guidelines - What’s new in the guidelines.
https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/0