What are the DHHS guidelines for antiretroviral therapy of acute HIV infection?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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Answer

Limited data are available to define the role of treatment in patients with acute HIV infection. Though studies suggest potential immunologic and virologic benefits, initiating treatment during acute infection remain theoretical. Treating acute infection may decrease the severity of acute disease, lower the level of chronic viremia following symptom resolution, decrease viral mutation, preserve immune function, and reduce transmission. [8]

Based on these potential benefits, it is recommended that all patients with HIV-1 infection, including those with early or acute infection, be treated with antiretroviral therapy. [8]   Combination therapy should be initiated similar to that administered in patients with chronic infection. Though resistance testing is recommended, therapy may be initiated prior to resistance results being available. With this in mind, protease inhibitor–based regimens should be considered first-line owing to the lower incidence of resistance to these agents in treatment-naïve patients. [8] Boosted-darunavir based therapy in combination with an NRTI backbone (tenofovir DF or tenofovir AF with emtricitabine or lamivudine) is generally the regimen of choice. Based on this rationale, providers could also consider dolutegravir- or bictegravir-based therapy in combination with the same NRTI backbone though data are limited on transmitted integrase resistance and efficacy in early HIV infection. [8]


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