Preferred initial regimens typically include a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and an integrase strand transfer inhibitor (INSTI).
Commonly recommended NRTI backbones are tenofovir disoproxil fumarate/emtricitabine or tenofovir alafenamide/emtricitabine.
The preferred INSTIs include dolutegravir, bictegravir, and raltegravir.
For patients who achieve viral suppression with daily oral regimens, long-acting injectable therapy with cabotegravir plus rilpivirine, administered every two months, is now an option.
Special considerations are made for specific populations, such as pregnant women, individuals with co-infections (e.g., tuberculosis, hepatitis B or C), and those with comorbid conditions like cardiovascular or renal disease.
For instance, dolutegravir/emtricitabine/tenofovir DF is recommended as a first-line regimen in pregnant women.
Monitoring of ART includes regular assessment of viral load and CD4 cell count to ensure efficacy and detect treatment failure early.
The goal is to achieve and maintain an undetectable viral load (<50 copies/mL).
In patients with established HIV, anti-retroviral therapy (ART) should be initiated as soon as possible after diagnosis.
ART initiation within seven days of new diagnosis improves viral suppression.
Randomized trials shows significant improvements in viral load suppression at 10 or 12 months and retention in care with the rapid initiation of therapy.
ART has led to dramayic improvements in the health of patients with advanced HIV in the prevention of disease progression in those without obvious clinical manifestations of HIV.
ART provides a new normal life expectancy for most patients with HIV who adhere to their treatment regimens.
It has eliminated the risk of transmitting the virus to an infected sexual partner.
Treatment with ART as a preventative measure has been a critical addition to the prevention of HIV with condom use, male circumcision, and screening of the blood supply.
Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression.
Pre-exposure prophylaxis studies has led to the conclusion that once daily single pill regimen is 99% effective in preventing sexual acquisition of HIV infection by an at risk uninfected person.
Patients with HIV infection, who received statins had a lower risk of major adverse cardiovascular events in those who receive placebo over median follow up of 5.1 years (REPRIEVE investigators).