What are the IAS-USA and DHHS antiretroviral treatment (ART) recommendations for HIV infection?

Updated: Jul 27, 2020
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Two sets of guidelines are commonly used in the United States, the Department of Health and Human Services (DHHS) and the International AIDS Society - USA Panel (IAS-USA), to determine when to treat and which treatment approach to use. The IAS-USA guidelines are generally updated every other year, with the most recent update occurring in August 2018. DHHS updated their treatment guidelines in December 2019, [11] reflecting changes in HIV prevention and care. While these two guidelines differ in some areas, for general practitioners, they represent similar strategies for HIV prevention through the use of PrEP and TasP, HIV treatment with INSTI-based regimens in most patients, and guidance for the use of alternative regimens in select patients.

While previous guideline versions have recommended waiting to initiate HIV treatment, the DHHS and IAS-USA guidelines both advocate initiation of HIV treatment as soon as possible, which some have termed "rapid" start of HIV medications. Some centers are able to do this on the same day as diagnosis. If patients are ready to begin treatment, it should be offered. Rapid-start protocols have been shown to improve patient retention in care, reduce the interval from diagnosis to virologic suppression, and, in small studies, demonstrate mortality benefit. As a result, Ending the Epidemic (ETE): A Plan for America recommends rapid treatment initiation as soon as possible in patients with newly diagnosed HIV infection. Excellent outcome data have been gathered and presented from San Francisco, New York City, and other cities, demonstrating the benefits of not waiting to start treatment.


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