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Recommendations for Use of Antiretroviral Agents for Prevention, Treatment of HIV Infection in Adults

Updated comprehensive recommendations provide clinicians with guidance on using antiretroviral therapy (ART) to prevent and treat HIV infections in adults. The 2022 Recommendations of the International Antiviral Society–USA Panel cover the gamut of care, from when and how to use ART for prophylaxis to managing adverse effects in patients on life-long ART.

“Initiation of ART is recommended as soon as possible after diagnosis of HIV,” write the volunteer expert physician scientists. “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.”

Editorial: “Many southern states have both high HIV incidence and the fewest LGBT protections,” editorialists write. “There are restrictions on LGBT-inclusive sexual education and discussion in schools and antitransgender policies and regulations against participation in sports. Alabama, Arkansas, Arizona, and Florida have enacted laws or policies that would ban or restrict care for transgender individuals, further stigmatizing and impeding one of the communities at the highest risk of HIV infection from engaging in comprehensive primary and LGBT care including HIV prevention services, with many other states inspired to incipient action. In Alabama, the state ban would make gender-affirming care for transgender youth a felony. In Texas, Oklahoma, and Tennessee, even in the absence of legislation, officials have been successful in restricting access to care for transgender youth. Many colleagues across the US are receiving threats simply because they provide gender-affirming care. These laws or proposed laws go against national and international medical associations’ recommendations for care of transgender individuals (which facilitates PrEP and HIV treatment), inhibit scientific research, and directly exacerbate the HIV epidemic by adding stigma, isolation, discrimination, and fear to those seeking gender-affirming care, and those providing that care.”

Source: JAMA