Overview of the Latest DHHS HIV Treatment Guidelines – Healthline

The Department of Health and Human Services (DHHS) is the U.S. federal government agency responsible for protecting the health of the American public.

The DHHS HIV guidelines help inform healthcare professionals of the best ways to treat HIV based on the latest clinical evidence and expert opinions.

In this article, we break down some of the key points of the DHHS guidelines and what to know about the most recent changes.

The main goal of the DHHS guidelines is to offer recommendations to healthcare professionals on the best treatment options for people with HIV. The guidelines are written and updated based on the most recent scientific evidence.

Doctors can consult these guidelines to determine the right treatment at various stages of HIV. For example, the guidelines provide recommendations on when to start antiretroviral therapy (ART), which drugs should be used, and what to do if initial treatment isnt working.

The full guidelines provide a long list of recommendations you can read here. Weve summarized some key points below so you can get an idea of the type of information these guidelines include.

Initial HIV treatment generally consists of two medications called nucleoside reverse transcriptase inhibitors in combination with a third active antiretroviral (ARV) drug from one of three drug classes:

The following drug regimens are classified as recommended initial regimens for most people with HIV. A slash (/) between medications means theyre available as a combination drug within the same pill:

When ART isnt working, several factors should be considered, including:

At the time this article was written, the DHHS guidelines were most recently updated on June 3, 2021.

Researchers are continuing to improve their understanding of how to best treat and manage HIV. The guidelines are updated periodically to include the latest research and expert opinions.

Heres an overview of the most recent changes included in the 2021 update.

New evidence from the Botswana Tsepamo Study, an ongoing observational study that started in 2014, suggests that the rate of neural tube defects (a type of structural change in a developing fetus) is lower than expected in women taking dolutegravir at the time of conception.

Dolutegravir is now recommended as an initial treatment option for people who may get pregnant.

The medication raltegravir was moved from recommended initial regimens for most people with HIV to recommended initial regimen in certain clinical situations.

The change was partially made due to the results of the Botswana Tsepamo Study. Since dolutegravir is now a viable treatment for people who can get pregnant, its no longer necessary to choose raltegravir over dolutegravir.

It was initially recommended that if ART treatment doesnt work, it should be followed by two and preferably three fully active ARV drugs.

Its now recommended that the new treatment can include two fully active drugs if at least one has a high resistance barrier. Examples of such drugs include boosted darunavir or dolutegravir. The change was made based on the results of ongoing clinical trials.

Updates include the mechanism behind declining CD4 counts despite suppressive ART.

CD4 cells are a type of white blood that fights infections. Knowing a persons CD4 count helps determine their risk of developing opportunistic infections.

The new guidelines also include updated strategies to reduce persistent inflammation.

Updates include the role of long-acting injectable regimens cabotegravir plus rilpivirine. Long-acting injectables are a new form of ART that involve infrequent injections instead of daily oral medication.

The Food and Drug Administration (FDA) approved the first long-acting injectable for treating HIV in January 2021.

The adolescent and young adults section has been updated to include current data on the rate of HIV among youth in the United States.

The guidelines now also have more details on the unique challenges that youth with HIV face compared to adults.

This section now includes data from a 2020 review of eight studies that found that women are more likely to gain weight than men after starting ART.

Theres also now more information regarding the effects of menopause and hormone replacement therapy while on HIV treatment.

This section now includes information about when to consider the long-acting injectable cabotegravir plus rilpivirine in people with a substance use disorder.

Current research is limited to people with good medication adherence.

Newly discovered drug interactions have been included in the guidelines, including interactions between the drugs cabotegravir plus rilpivirine and fostemsavir.

A section was added discussing the cost effectiveness of new drugs, such as ibalizumab, in HIV thats resistant to multiple ARV drugs.

Monthly prices of commonly prescribed ARV drugs have been updated with 2021 prices.

Updates describe current recommendations for ARV drugs that can be used if 3 months of isoniazid and rifapentine are prescribed for tuberculosis.

There are many free or low-cost programs available to help people with HIV. Here are some resources that may be helpful:

The DDHS HIV guidelines were developed to help healthcare professionals stay up to date with the latest HIV research so they can provide the best possible treatment. The guidelines are updated regularly as new research or evidence becomes available.

The guidelines are available online for free to anybody who wants to read them.

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Overview of the Latest DHHS HIV Treatment Guidelines - Healthline