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Special Communication
October 14, 2020

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society–USA Panel

Author Affiliations
  • 1University of Alabama at Birmingham
  • 2Harvard Medical School and Massachusetts General Hospital, Boston
  • 3Monash University and Alfred Hospital, Melbourne, Australia
  • 4University of California, Los Angeles
  • 5AIDS Research Consortium of Atlanta, Atlanta, Georgia
  • 6Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
  • 7University of California, San Diego, La Jolla
  • 8San Francisco Department of Public Health and University of California, San Francisco
  • 9Emory University School of Medicine, Atlanta, Georgia
  • 10School of Medicine, University of North Carolina, Chapel Hill
  • 11University Hospital Cologne, Cologne, Germany
  • 12University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
  • 13University of Paris and Saint-Louis/Lariboisière Hospitals, APHP, Paris, France
  • 14International Antiviral Society–USA, San Francisco, California
  • 15University of California, San Francisco
JAMA. 2020;324(16):1651-1669. doi:10.1001/jama.2020.17025

Importance  Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices.

Objective  To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV.

Evidence Review  New evidence was collected since the previous International Antiviral (formerly AIDS) Society–USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations.

Findings  From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic.

Conclusion and Relevance  Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

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1 Comment for this article
Declines in HIV Testing With COVID-19
Takuma Hayashi, MBBS, GMRC, D.M.Sci., | National Hospital Organization Kyoto Medical Center
With the spread of COVID-19 around the world, serious problems have also been identified regarding public testing for AIDS. On August 15, 2020, the AIDS Trends Committee of Japan Ministry of Health, Labor and Welfare announced that the number of AIDS virus (HIV) tests from April to June 2020 was 9584, which is about a quarter of the same period of 2019. It is possible that the reason for the significant decrease in the number of tests is that due to the expansion of COVID-19, some health centers have stopped the tests and the number of people refraining from seeing doctors has increased. The number (11,689) of consultations regarding AIDS in 2020 has also decreased to about one-third of the same period of 2019.

The AIDS Trends Committee of Japan Ministry of Health, Labor and Welfare has issued a public call that people suspected of being infected with HIV should be actively tested. Unless this situation is improved immediately, it is expected that the number of patients with AIDS will increase worldwide.