HIV Treatment Considerations

The Importance of Starting HIV Treatment Early

Initiating HIV treatment early may result in better clinical outcomes1,2

DHHS and IAS-USA guidelines support HIV treatment initiation immediately (or as soon as possible), regardless of CD4 cell count. According to DHHS, rapid treatment initiation 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

Verified person icon representing undetectable HIV status.

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

US map icon representing 35000 HIV infections each year.

Each year, ~35,000 NEW HIV INFECTIONS are diagnosed in the US5,†

2019 data.

Icon of virus representing 8 in 10 new HIV infections from PLWH not in care.

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

Icon of multiple viruses representing 1 in 5 infections are transmitted from PLWH in care but not virologically suppressed.

1 in 5 TRANSMISSIONS were transmitted from PLWH who were in care but not virologically suppressed3,‡

2016 data.

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

How do you identify barriers that may affect your patients’ treatment goals?

Explore some of the key factors that Dr. Joel Gallant and Dr. Calvin Cohen considered to achieve durable viral suppression.

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 virus icon.

HIV is one of the fastest-mutating pathogens and can mutate millions of times per day8

Mutation affecting ARV proteins.

Mutations can affect ARV target proteins, resulting in potential drug resistance11

1 in 5 patients resistance to >=1 ARV graphic.

In an analysis of HIV sequences reported to NHSS from 2014 to 2018,


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.

Please see full Prescribing Information for BIKTARVY® and DESCOVY®, including BOXED WARNINGS.

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.

Reference: 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 December 06, 2023. Accessed December 07, 2023. 2. Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society—USA Panel. JAMA. 2023;329(1):63-84. 3. Centers for Disease Control and Prevention. Ending the HIV epidemic. Updated March 18, 2019. Accessed March 16, 2022. 4. Li Z, Purcell DW, Sansom SL, Hall HI. Vital signs: HIV transmission along the continuum of care—United States, 2016. MMWR Morb Mortal Wkly Rep. 2019;68(11):267-272. 5. U.S. Statistics. Updated June 2, 2021. Accessed March 16, 2022. 6. Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. Department of Health and Human Services. National Institutes of Health News Releases. Released May 2015. Accessed June 14, 2020. 7. Centers for Disease Control and Prevention. Monitoring selected HIV prevention and care objectives by using surveillance data—United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report, 2019; vol 26(2). Published May 2021. Accessed March 26, 2022. 8. Sanjuán R, Domingo-Calap P. Mechanisms of viral mutation. Cell Mol Life Sci. 2016;73(23):4433-4448. 9. Clavel F, Hance AJ. HIV drug resistance. N Engl J Med. 2004;350(10):1023-1035. 10. Perelson AS, Neumann AU, Markowitz M, Leonard JM, Ho DD. HIV-1 dynamics in vivo: virion clearance rate, infected cell life-span, and viral generation time. Science. 1996;271(5255):1582-1586. 11. Perelson AS. Modelling viral and immune system dynamics. Nat Rev Immunol. 2002;2(1):28-36. 12. Wensing AM, Calvez V, Günthard HF, et al. 2017 update of the drug resistance mutations in HIV-1. Top Antivir Med. 2017;24(4):132-133. 13. McClung RP, Oster AM, Ocfemia MCB, et al. Transmitted drug resistance among human immunodeficiency virus (HIV)-1 diagnoses in the United States, 2014-2018. Clin Infect Dis. 2022;74(6):1055-1062.