Updates to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV

The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) updated the HIV-2 Infection Section of Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Highlights from the updated Section are summarized below: 

• Because HIV-2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors, the long-acting injectable regimen of cabotegravir (CAB) and rilpivirine is not recommended for people with HIV-2.
• Limited data showed that HIV-2 also is resistant to fostemsavir; therefore, this drug should not be used in people with HIV-2.
• For patients with multidrug-resistant viruses, ibalizumab and lenacapavir demonstrate in vitro potency against HIV-2 and may be considered.
• A new clinical trial on the use of dolutegravir has been added to support the use of integrase strand transfer inhibitors (INSTIs) for people with HIV-2.
• The Panel noted that when available, some clinicians prefer using boosted darunavir (DRV) over lopinavir/ritonavir for treatment of HIV-2 infection because DRV is better tolerated.

The Early (Acute and Recent) HIV Infection section has been updated to include an extended analysis from the HPTN 083 study, which evaluated the role of long-acting CAB (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV. This analysis reported on cases of HIV in the CAB-LA arm (some of which occurred despite on-time CAB injections), delays in HIV diagnosis, and the identification of major INSTI-resistance mutations. These results reinforce the importance of screening for INSTI-resistance mutations prior to initiation of an INSTI regimen in a person with a history of CAB-LA used for PrEP and a diagnosis of HIV. 

For a list of recent updates, please see What's New in the Guidelines. To view or download the Guidelines, go to the Adult and Adolescent Antiretroviral Guidelines section of Clinical Info’s website. The guidelines tables and recommendations also can be downloaded as separate PDF files. 

Clinicalinfo welcomes your feedback on the latest revisions to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Please send your comments with the subject line “Adult and Adolescents Antiretroviral Guidelines” to HIVinfo@NIH.gov by December 26, 2023.