In April 2019, the U.S. Food and Drug Administration approved a combination pill comprising the integrase inhibitor dolutegravir (DTG), 50 mg, and the NRTI lamivudine (3TC), 300 mg, for use as a complete ARV regimen for initial HIV treatment of patients. The approval specifies that DTG/3TC is intended only for adults who have never received ART and whose HIV has no resistance to either of the two components. It is to be taken once daily without food restrictions.
Immediate antiretroviral therapy (ART) refers to starting HIV treatment as soon as possible after the diagnosis of HIV infection, preferably on the first clinic visit (and even on the same day the HIV diagnosis is made). This strategy also is known as "rapid ART," "same-day ART," and "treatment upon diagnosis."
Immediate ART initiation may bring earlier benefits in personal health, and earlier reductions in the risk of onward transmission of HIV. For persons with acute infection, immediate ART may limit the HIV viral reservoir.
The emergence of chronic disease complications in controlled HIV disease has changed the landscape of HIV clinical care. HIV infection confers an increased cardiovascular disease risk which is thought to be due to a complex interplay of mechanistic factors. While traditional cardiovascular risk factors likely play a role, recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risk.[i]
Regional AETCs across the United States are working to bring new clinicians into the HIV workforce through inter-professional education (IPE) programs. IPE trains learners in teams in clinical settings where trainees learn from, about, and through each other. One project in Los Angeles is conducting their IPE program through three separate health campuses for nursing (Charles Drew University), medicine (University of California, Los Angeles), and pharmacy (University of Southern California). Cross-posted from TargetHIV coverage of the 2018 National Ryan White Conference.
Taking effective HIV medications as prescribed offers many benefits for people with HIV—life expectancy normalizes and viral loads drop below detectable levels, preventing the risk of sexual transmission in those who achieve and maintain durable viral suppression. Unfortunately, many individuals face significant challenges to adhering to a daily regimen of antiretroviral therapy (ART).
Antiretroviral therapy (ART) has been very successful at preserving immune function and controlling opportunistic infections among individuals infected with HIV. Oral mucosal diseases associated with advanced immunosuppression, including candidiasis and hairy leukoplakia, are significantly less common among patients on ART.
The AETC Program was well represented at the 2018 National Ryan White Conference on HIV Care & Treatment. The AETC National Coordinating Resource Center exhibited an array of AETC Program developed resources and promotional items.
The International AIDS Society (IAS)-USA recently released its 2018 HIV treatment and prevention recommendations. The document is particularly notable for its discussion of "When to Start ART."
When a patient presents to your emergency department, urgent care or clinic with a chief complaint of sexual assault within the last 24 hours, the challenge is recognizing that, along with safety and criminal justice concerns, this patient has emergent health needs. One of the most urgent of these is that the patient may have been exposed to HIV. Non-occupational post-exposure prophylaxis (nPEP) needs to be initiated as soon as possible after known or potential HIV exposure, but throughout the country, there are barriers to this treatment.
The U.S. Food and Drug Administration has approved the NNRTI doravirine for use in initial HIV therapy. FDA approval was based on 48-week results of 2 Phase III studies in treatment-naive persons that showed doravirine + 2 NRTIs resulted in similar rates of viral suppression at 48 weeks as either efavirenz + 2 NRTIs or darunavir/ritonavir + 2 NRTIs. Recommended dosing is 100 mg once daily, with or without food.