On December 1, the International Antiviral Society-USA (IAS-USA) updated its recommendations for the prevention and treatment of HIV and the management of overall health for people living with the virus. The guidelines are based on a review of relevant studies since the last update in 2022. The adoption of long-acting antiretrovirals was a key theme during this period.

 

The IAS-USA recommendations are comparable to those from the Department of Health and Human Services, which were updated in October. Both recommend that all people diagnosed with HIV should begin antiretroviral therapy as soon as possible. For most people, recommended initial regimens include an oral integrase inhibitor, specifically bictegravir (in the Biktarvy combination pill) or dolutegravir (Tivicay). Long-acting injectable Cabenuva (cabotegravir and rilpivirine) is also an option for those who prefer not to take or struggle with adherence to daily pills.

 

Beyond antiretroviral treatment, the revision includes recommendations on HIV pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (doxyPEP) for the prevention of sexually transmitted infections. It also includes advice on managing cardiovascular risk, weight changes and substance use disorders among people living with HIV and a new section on cancer, which contributes to 20% to 30% of all HIV-related deaths.

 

Throughout the recommendations, the authors discuss barriers that impede access to HIV prevention, treatment and care. “Although the tools are available, efforts must be redoubled to reduce disparities and address inequities to realize the promise of ending the HIV epidemic,” they wrote.