Adult Antiretroviral Guidelines

US DHHS Guidelines with Australian Commentary

Guidelines

Virologic Failure

AU Comment: Australian Special Access Scheme for ARV treatments In heavily treatment-experienced patients, where treatment options are limited by drug resistance, toxicities or other issues, enrolment in a clinical trial of a new antiretroviral agent (if available), or use of an agent not yet TGA-approved for marketing but available through the Special Access Scheme, can …

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Poor CD4 Cell Recovery

AU Comment: Poor CD4 cell recovery and persistent inflammation despite viral suppression Current DHHS recommendations are suitable for implementation in Australia, including the following points: In individuals with viral suppression, adding ARV drugs or switching ARV drug classes does not consistently improve CD4 cell recovery or reduce all relevant markers of immune activation and is not …

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Optimising ART in the Setting of Virologic Suppression

Panel’s Recommendations for Optimizing Antiretroviral Therapy in the Setting of Virologic Suppression Key Considerations and Panel’s Recommendations Advances in antiretroviral (ARV) treatment and a better understanding of HIV drug resistance have made it possible to consider switching a person with HIV from an effective ARV regimen to an alternative ARV regimen in some situations. The …

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Discontinuation or Interruption of ARV

AU Comment: Ibalizumab (IBA) Ibalizumab (IBA) a monoclonal antibody that is NOT PBS listed in Australia. Discontinuation or interruption of antiretroviral therapy (ART) may result in viral rebound, immune decompensation, and/or clinical progression.1-5 Thus, discontinuation or planned interruption of ART is not recommended outside the context of a clinical trial (AI). However, unplanned interruption of ART may …

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What to Start

This section has information on What to Start. Please click on the below links or follow the table of contents to access the information you are looking for. Initial Combination ARV Regimens for People with HIV Nucleoside Reverse Transcriptase Inhibitor Non-Nucleoside Reverse Transcriptase Inhibitor-Based Regimens Other ARV Regimens ARV Components or Regimens Not Recommended as …

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Selecting an ART regimen

AU comment: CAB-LA in Australia Long-acting cabotegravir (CAB-LA) for PrEP was TGA approved in 2022 but as of June 2024 the process for listing this medication on the PBS has ceased. However, some patients may have accessed CAB-LA as PrEP while overseas. Clinicians should ensure that integrase genotypic resistance testing is requested to exclude integrase …

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Nucleoside Reverse Transcriptase Inhibitor

AU comment: Doravirine The non-nucleoside reverse transcriptase inhibitor doravirine (DOR), was approved by the TGA in 2020 as a single drug or as a fixed dose combination with TDF and lamivudine (3TC). DOR/TDF/3TC is NOT reimbursed under the PBS in Australia. Summary The Food and Drug Administration (FDA)-approved nucleos(t)ide reverse transcriptase inhibitors (NRTIs) include zidovudine …

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Integrase Strand Transfer Inhibitor–Based Regimens

Summary Four integrase strand transfer inhibitors (INSTIs)—bictegravir (BIC), dolutegravir (DTG), elvitegravir (EVG), and raltegravir (RAL)—are approved for use in antiretroviral therapy (ART)-naive patients with HIV. Cabotegravir (CAB) is a new INSTI that is approved to be used with rilpivirine (RPV) as part of a long-acting injectable complete antiretroviral (ARV) regimen to replace a stable oral …

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Non-Nucleoside Reverse Transcriptase Inhibitor-Based Regimens

Summary Five NNRTIs—delavirdine (DLV), doravirine (DOR), efavirenz (EFV), etravirine (ETR), nevirapine (NVP), and rilpivirine (RPV) are currently approved by the Food and Drug Administration (FDA) for the treatment of HIV when used in combination with other antiretroviral (ARV) drugs. This section of the guidelines will focus on DOR, EFV, and RPV, the three NNRTIs recommended …

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