title: Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.
abstract: OBJECTIVE
  New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults.
  
  
  OBJECTIVE
  To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis.
  
  
  METHODS
  A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence.
  
  
  RESULTS
  Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure.
  
  
  CONCLUSIONS
  Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.
authors.affiliation: University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
authors.affiliation: University of Alabama at Birmingham, Birmingham.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: University of California San Diego School of Medicine, San Diego.
authors.forename: Constance A
authors.initials: CA
authors.lastname: Benson
authors.affiliation: Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Southwest CARE Center, Santa Fe, New Mexico.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Gallant
authors.affiliation: Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
authors.affiliation: University of Alabama at Birmingham, Birmingham.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sax
authors.affiliation: AIDS Research Consortium of Atlanta, Atlanta, Georgia.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Thompson
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston.
authors.forename: Rajesh T
authors.initials: RT
authors.lastname: Gandhi
authors.affiliation: University of California Los Angeles.
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Landovitz
authors.affiliation: University of California San Diego, La Jolla.
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: International Antiviral Society-USA, San Francisco, California.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Jacobsen
authors.affiliation: University of California San Francisco.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Volberding
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis; D065129:Pre-Exposure Prophylaxis; D011247:Pregnancy; D011379:Prognosis; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents