Universität zu Köln

Saag, Michael S., Benson, Constance A., Gandhi, Rajesh T., Hoy, Jennifer F., Landovitz, Raphael J., Mugavero, Michael J., Sax, Paul E., Smith, Davey M., Thompson, Melanie A., Buchbinder, Susan P., del Rio, Carlos ORCID: 0000-0002-0153-3517, Eron, Joseph J., Jr., Faetkenheuer, Gerd, Gunthard, Huldrych F., Molina, Jean-Michel, Jacobsen, Donna M. and Volberding, Paul A. (2018). Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA-J. Am. Med. Assoc., 320 (4). S. 379 - 397. CHICAGO: AMER MEDICAL ASSOC. ISSN 1538-3598

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Abstract

IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society-USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with ant retroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Saag, Michael S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Benson, Constance A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gandhi, Rajesh T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoy, Jennifer F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Landovitz, Raphael J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mugavero, Michael J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sax, Paul E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Smith, Davey M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Thompson, Melanie A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchbinder, Susan P. UNSPECIFIED UNSPECIFIED UNSPECIFIED del Rio, Carlos UNSPECIFIED orcid.org/0000-0002-0153-3517 UNSPECIFIED Eron, Joseph J., Jr. UNSPECIFIED UNSPECIFIED UNSPECIFIED Faetkenheuer, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Gunthard, Huldrych F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Molina, Jean-Michel UNSPECIFIED UNSPECIFIED UNSPECIFIED Jacobsen, Donna M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Volberding, Paul A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-179536
DOI:	10.1001/jama.2018.8431
Journal or Publication Title:	JAMA-J. Am. Med. Assoc.
Volume:	320
Number:	4
Page Range:	S. 379 - 397
Date:	2018
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	1538-3598
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TENOFOVIR DISOPROXIL FUMARATE; HUMAN-IMMUNODEFICIENCY-VIRUS; ATAZANAVIR/RITONAVIR PLUS LAMIVUDINE; VIROLOGICALLY SUPPRESSED ADULTS; DEMAND PREEXPOSURE PROPHYLAXIS; MULTIDRUG-RESISTANT HIV-1; CD4 CELL COUNT; DOUBLE-BLIND; NON-INFERIORITY; COST-EFFECTIVENESS Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17953