Antiretroviral Drugs for HIV Clinical Practice Guidelines (IAS-USA, 2022)

International Antiviral (formerly AIDS) Society–USA

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

December 09, 2022

Updated clinical practice guidelines for antiretroviral drugs for HIV were published in December 2022, by the International Antiviral (formerly AIDS) Society–USA in JAMA.[1]

Key Recommendations for When to Start Antiretroviral Therapy (ART)

Begin ART as soon as feasible after diagnosis, preferably within 7 days, including the day of diagnosis or at the initial clinic visit, provided the patient is ready and there is no reason to suspect a concurrent opportunistic infection.

Some structural barriers could delay the patient’s receipt of ART, even on the same day as the patient’s visit; these can interfere with care engagement, access to continuous ART, and adherence to ART. The clinician should identify and discuss these with the patient using evidence-based approaches.

Starting ART at the time of diagnosis in patients with acute HIV infection is recommended.

Opportunistic infections

ART should begin within 2 weeks of beginning treatment for most opportunistic infections.

For those with active tuberculosis and with no evidence of tuberculous meningitis, initiate ART within 2 weeks after beginning tuberculosis treatment, especially for patients with a CD4 cell count less than 50/μL.

For patients with tuberculous meningitis, begin high-dose steroids at the same time as tuberculosis treatment, and start ART within 2 weeks after beginning tuberculosis treatment and steroids.

For patients with cryptococcal meningitis who are located near close monitoring and supportive care for adverse events, begin ART 2 to 4 weeks after initiating antifungal therapy. Patients who are ART-naïve, have asymptomatic cryptococcal antigenemia, and have a negative lumbar puncture result without evidence of cryptococcal meningitis should begin ART immediately.

Begin ART immediately in patients with a new cancer diagnosis and pay attention to drug-drug interactions.

For more information, please go to HIV Infection and AIDS, Antiretroviral Therapy for HIV Infection, and Primary Care of Patients With HIV Infection.


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