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HIV Guidelines Cheat Sheet (DRAFT) by

Current HIV guidelines

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Screening and Evaluation

Who to Screen and What to Screen For

The Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommend screening the following groups of people:
The following should be included in the baseline evalua­tion:
 • Everyone between 13 and 64 years of age (at least once)
 • Complete medical history
 • Indivi­duals who engage in high-risk behaviors (annually)
   - Men who have sex with men (MSM)
   - People who have had anal or vaginal sex with someone who has HIV
   - People who have had ≥1 sex partner since their last HIV test
   - People who share needles, syringes, or other drug injection equipment
   - People who have exchanged sex for drugs or money
   - People who have been diagnosed with or are being treated for another sexual­ly-­tra­nsm­itted infection, hepatitis, or tuberc­ulosis (TB)
   - People who have had sex with anyone who has done any of the above or whose sexual history is unknown
 • Lab tests
  - HIV antige­n/a­ntibody testing
  - CD4 count
  - HIV RNA (viral load)
  - Complete blood count (CBC)
  - Chemistry panel
  - Urinalysis
  - Hepatitis A, B, and C serologies
  - Lipid panel
  - HLA-B*5701 test†
  - Genotypic drug-r­esi­stance testing
  - Sexually transm­itted infection (STI) screening
  - Opport­unistic infection screening
  - Cancer screening
  - Immuni­zation history
  - Pregnancy test
 • Gay and bisexual men (every 3 to 6 months)
 • Physical exam
 • Pregnant people (each pregnancy)
 • Patient Counseling

Treatment

Treatment Goals

Prevention of HIV-as­soc­iated morbidity and mortality
Maximal and durable suppre­ssion of HIV viral load
Restor­ation and preser­vation of immune function
Improv­ement in quality of life
Prevention of HIV transm­ission

Initiation of Treatment

Who is antire­tro­viral therapy (ART) recomm­ended for?
All persons with HIV (to prevent morbidity and mortality and to prevent transm­ission of HIV to others)
When should ART be initiated, and why?
ART should be initiated at diagnosis, if possible, or as soon as possible afterward in order to:
 (1) increase ART uptake,
 (2) decrease time to viral suppre­ssion, and
 (3) improve the rate of virologic suppre­ssion
What do patients need to know when beginning on ART?
Patients should be educated on the benefits of ART and strategies to improve adherence with healthcare visits and their medica­tions.

Treatment Pearls

• ART typically consists of 3 to 4 agents from 2 or more drug classes. Monoth­erapy is not recomm­ended.
• When choosing an ART regimen for a patient, it is important to consider pre-tr­eatment labs, previous treatment regimens, drug resist­ance, individual prefer­ences, likelihood of adherence to treatment, and presence of coinfe­ctions, comorb­idi­ties, and pregnancy.
 

Recomm­ended for Treatm­ent­-Naïve Patients

INSTI + 2 NRTIs
• BIC/TAF/FTC
• DTG/(TAF or TDF)/(FTC or 3TC)
INSTI + NRTI
•DTG/3TC*
These regimens are recomm­ended for most people with HIV who have no history of using long-a­cting injectable cabote­gravir (CAB-LA) as pre-ex­posure prophy­laxis (PrEP).

* Use only if HIV RNA <50­0,000 copies/mL, no HBV coinfe­ction, and genotypic resistance testing results are available.

Recomm­ended for Patients Exposed to CAB-LA

Boosted PI + 2 NRTIs
• DRV/(COBI or RTV)/(TAF or TDF)/(FTC or 3TC)
These regimens are recomm­ended for most people with HIV who have a history of using CAB-LA as pre-ex­posure prophy­laxis (PrEP).

Other Regimens for Certain Clinical Scenarios

Regimen
When to Use
DTG/AB­C/3TC
When wanting to avoid TAF or TDF due to risk of renal- or bone-r­elated adverse effects