HIV Treatment Considerations
DHHS and IAS-USA guidelines support HIV treatment initiation immediately (or as soon as possible), regardless of CD4 cell count. According to DHHS, early treatment may:
- Increase the uptake of ART and linkage to care
- Decrease the time to virologic suppression for individual patients
- Improve the rate of virologic suppression among persons with HIV
Additional treatment initiation guidance from DHHS1
- When initiating therapy, it is important to educate patients on the benefits and considerations of treatment and adherence
In 2016, 23% of all people living with HIV who knew that they had HIV, but weren't actively in care, accounted for 43% of new HIV transmissions3,*
*According to the US Centers for Disease Control and Prevention.
How do you discuss starting treatment early with your patients?
Listen to Dr. Joel Gallant and Dr. Calvin Cohen as they reflect on the importance of early treatment initiation and how it changed the conversation with their patients.
Early and Effective HIV Treatment Is Crucial1,3-6
According to the CDC, starting people living with HIV (PLWH) on HIV treatment as soon as possible so they may reach undetectable status is critical3
Each year, ~35,000 NEW HIV INFECTIONS are diagnosed in the US5,†
8 in 10 NEW HIV TRANSMISSIONS come from PLWH not in care3
The NIH recommends starting PLWH on treatment early, while their CD4 counts may still be high, in order to reduce their risk of developing AIDS or other serious illnesses.
When starting PLWH on ARV therapy, consider the benefits of initiating treatment as soon as possible
Only half of the >1.2 million PLWH in the US are retained in care, and just over half were virologically suppressed, according to 2019 CDC data.7
1 in 5 TRANSMISSIONS were transmitted from PLWH who were in care but not virologically suppressed3,‡
According to DHHS guidelines, when people with HIV achieve and maintain an undetectable viral load for at least 6 months, it prevents sexual transmission of HIV to their partners1
A Treatment With a High Barrier to Resistance Is Key1,8-12
Drug-resistant mutations may develop depending on a medicine's barrier to resistance and during periods when drug levels are suboptimal
HIV is one of the fastest-mutating pathogens and can mutate millions of times per day8
Mutations can affect ARV target proteins, resulting in potential drug resistance11
In an analysis of HIV sequences reported to NHSS from 2014 to 2018,
1 IN 5 TREATMENT-NAÏVE PATIENTS IN THE US (n=9616/50747) DEMONSTRATED RESISTANCE TO ≥1 ARV13
One particular concern is cross-resistance, an HIV mutation that confers resistance to drugs in the same ARV class, rendering them ineffective—thus limiting treatment options2
How important is resistance to your treatment decisions?
Early clinical developments working to achieve viral suppression often had their own challenges. Resistance was top among them, and it remains a crucial concern when treating patients living with HIV.
ART, antiretroviral therapy; ARV, antiretroviral; CD4, cluster of differentiation 4; CDC, Centers for Disease Control and Prevention; DHHS, US Department of Health and Human Services; IAS-USA, International Antiviral Society–USA; NHSS, National HIV Surveillance System.
1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated May 26, 2023. Accessed June 26, 2023. https://