Which medication mechanism describes the action of delavirdine in a client with HIV

Medication Summary

Effective antiretroviral therapy is the most important intervention in terms of improving longevity and preventing opportunistic infections in patients with human immunodeficiency virus (HIV) infection. Therapy should involve combinations of drugs recommended by current guidelines. Recommendations are specific for various patient groups (eg, treatment naïve, treatment experienced, coinfection with hepatitis C). [7] Antiretroviral drug classes and agents within each class are listed in Table 1, below (see individual medication tables for more detail).

Many of the antiretroviral drugs that have been approved for HIV-infected adults and adolescents are gaining FDA approval for use in younger children. For more information, see Pediatric HIV Infection.

Of the antiretroviral drugs that have been approved, several are no longer being manufactured either because of the development of improved formulations (ie, amprenavir replaced by fosamprenavir) or because of limited use (ie, delavirdine and zalcitabine [ddC]).

Several combination products that contain tenofovir alafenamide (TAF) are now approved in the United States. TAF is a more targeted form of tenofovir that has demonstrated high antiviral efficacy at a dose that is 10 times lower than that of tenofovir DF, as well as an improved renal and bone safety profile.

Table 1. Antiretroviral Drug Classes and Agents (Open Table in a new window)

Combination therapy has been shown to dramatically reduce the likelihood of drug resistance (many drug-resistant mutations are mutually exclusive) and to suppress viral replication to the point that progression to AIDS is significantly slowed. Antiviral-resistance mutations often affect more than one drug simultaneously because of similar development pipelines and the ultimate molecular structure of the drug, and combination choices should account for this possibility.

Ritonavir, a PI that may be used in its own right, boosts blood levels of other PIs. This permits a reduced dosage of the coadministered drug. Various products have been formulated to include PIs combined with ritonavir.

Combination products

Numerous antiretroviral combination products are available on the market to assist patients with compliance and decrease the daily number of tablets and capsules required (see Table 2, below).

Table 2. Antiretroviral Combination Products (Open Table in a new window)

A subgroup analysis of black patients with HIV enrolled in the 48-week, open-label SPIRIT (Switching PI to Rilpivirine In-combination with Truvada) trial showed that switching from an antiretroviral regimen consisting of a boosted PI and ritonavir (RTV) plus 2 nucleoside/nucleotide reverse-transcriptase inhibitors (PI+RTV+2NRTIs) to a simplified once-daily, single-tablet regimen of rilpivirine/emtricitabine/tenofovir DF (RPV/FTC/TDF) is safe and effective in this population. [161, 162]

Patients were randomized to undergo an immediate switch to RPV/FTC/TDF at baseline or to maintain their PI+RTV+2NRTIs regimen for 24 weeks and then switch to RPV/FTC/TDF for 24 weeks (delayed switch).

At 24 weeks, a subgroup analysis of black patients in the study showed that viral suppression rates (HIV-1 RNA < 50 copies/mL) were 95% in the RPV/FTC/TDF group and 91% in the group receiving PI+RTV+2NRTIs; ie, no significant difference existed. At 48 weeks, 89% of black patients in the immediate-switch group maintained viral suppression, compared with 95% of those in the delayed-switch group, which again was not considered a significant difference. [161, 162]

At 48 weeks, when all patients in the study were taken into account, there was no significant difference in viral suppression between the immediate-switch (89%) and delayed-switch (92%) groups; the rates of adverse events were similar in both groups as well. [161, 162] However, investigators noted significant improvement in lipid levels in patients who received the single-tablet RPV/FTC/TDF regimen. [162]

The FDA has approved a once-daily, fixed-dose triple-combination pill (Triumeq) containing the antivirals dolutegravir, abacavir, and lamivudine for the treatment of patients aged 18 years or older with HIV infection. The FDA based its approval primarily on the results of 2 studies, in one of which, a 96-week study in treatment-naive adults, virologic suppression occurred in 80% of patients receiving dolutegravir and abacavir/lamivudine (administered separately), compared with 72% of patients taking a single-pill regimen of efavirenz, emtricitabine, and tenofovir (Atripla). [163]

The FDA approved the NNRTI doravirine in August 2018. Also with this new drug, a complete regimen combination containing doravirine/lamivudine (3TC)/tenofovir DF (TDF) was also approved. Approval was based on the DRIVE-FORWARD clinical trial (n=766). Patients who were antiretroviral-naïve were randomly assigned to once-daily treatment with doravirine or darunavir 800 mg plus ritonavir 100 mg (DRV+r), each in combination with emtricitabine (FTC)/TDF or abacavir (ABC)/3TC. Treatment with doravirine led to sustained viral suppression through 48 weeks, meeting its primary endpoint of noninferiority compared with DRV+r, each in combination with FTC/TDF or ABC/3TC. At week 48, 84% of the doravirine group and 80% of the DRV+r group had plasma HIV-1 RNA levels of less than 50 copies/mL. [164]

The doravirine/3TC/TDF combination was approved based on data from the DRIVE-AHEAD trial (n=728). Patients who were antiretroviral-naïve were randomly assigned to once-daily treatment with doravirine/3TC/TDF or efavirenz (EFV)/emtricitabine/tenofovir disoproxil fumarate (EFV 600 mg/FTC 200 mg/TDF 300 mg). The doravirine/3TC/TDF combination provided sustained viral suppression through 48 weeks, meeting its primary endpoint of noninferiority compared with EFV/FTC/TDF. At week 48, 84% of the doravirine/3TC/TDF group had plasma HIV-1 RNA levels of less than 50 copies/mL, as did 81% of the EFV/FTC/TDF group. [165]

Antiretroviral agent, nucleoside reverse-transcriptase inhibitor

Class Summary

NRTIs agents inhibit viral replication by inhibiting viral RNA–dependent DNA polymerase.

Abacavir (Ziagen)

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This NRTI interferes with HIV viral RNA–dependent DNA polymerase and inhibits viral replication. Guidelines from the Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection recommends screening for HLA-B*5701 before starting patients on a regimen that contains abacavir, to reduce the risk of hypersensitivity reaction.

Didanosine (Videx, Videx EC)

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Didanosine interferes with HIV viral RNA–dependent DNA polymerase and inhibits viral replication.

Emtricitabine (Emtriva)

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This agent is a synthetic nucleoside cytosine analog classified as an NRTI. It competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain termination.

Lamivudine (Epivir)

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Lamivudine is a thymidine analog that inhibits viral replication.

Stavudine (Zerit, Zerit XR)

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Stavudine competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain termination.

Tenofovir disoproxil fumarate (Viread)

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This agent inhibits the activity of HIV reverse transcriptase by competing with the natural substrate deoxyadenosine 5'-triphosphate and, after incorporation into DNA, by DNA chain termination. It is administered as the prodrug bis-isopropoxycarbonyloxymethyl ester derivative of tenofovir, which is converted, through various enzymatic processes, to tenofovir, a nucleotide analog of adenosine 5'-monophosphate. Bioavailability is enhanced by a high-fat meal. Prolonged intracellular distribution allows for once-daily dosing.

This drug has shown substantial efficacy and safety in PReP trials with IV drug users and heterosexually active adults. CDC guidelines recommend tenofovir alone as an alternative regimen to emtricitabine/tenofovir for these populations, but not for MSM, among whom its efficacy has not been studied.

Zidovudine (Retrovir)

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Zidovudine is a thymidine analog that inhibits viral replication.

Antiretroviral Agent, Protease Inhibitor

Class Summary

PIs inhibit protein precursors necessary for HIV infection of uninfected cells.

Atazanavir (Reyataz)

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An azapeptide HIV-1 PI, atazanavir prevents virion maturation by selectively inhibiting Gag and Gag-Pol polyproteins in HIV-1–infected cells.

Darunavir (Prezista)

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This HIV-1 PI selectively inhibits HIV-encoded Gag-Pol polyprotein cleavage in infected cells, thereby preventing mature virus particle formation. It is indicated for HIV disease that has not responded to treatment with other antiretroviral agents. Coadminister with low-dose ritonavir (ritonavir-boosted therapy decreases elimination and increases darunavir serum concentration).

Darunavir is typically coadministered with other anti-HIV agents (eg, NRTIs). Food increases maximum plasma concentration (Cmax) and area under the curve (AUC). This agent is indicated for HIV infection in antiretroviral treatment–experienced adults (eg, those with HIV-1 strains resistant to more than one PI).

Fosamprenavir (Lexiva)

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Fosamprenavir is a prodrug that is converted to amprenavir by cellular phosphatases in vivo.

Lopinavir and ritonavir (Kaletra)

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Lopinavir inhibits HIV protease and renders the enzyme incapable of processing polyprotein precursor, leading to production of noninfectious immature HIV particles. Ritonavir inhibits CYP3A metabolism of lopinavir, increasing plasma levels of lopinavir.

Nelfinavir (Viracept)

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Nelfinavir inhibits HIV-1 protease, resulting in the production of an immature and noninfectious virus.

Indinavir (Crixivan)

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Indinavir prevents formation of protein precursors necessary for HIV infection of uninfected cells and viral replication.

Ritonavir (Norvir)

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This HIV PI is used as a part of double or triple therapy with nucleosides and other protease inhibitors.

Saquinavir (Invirase)

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Saquinavir inhibits HIV protease and renders the enzyme incapable of processing polyprotein precursor, leading to production of noninfectious immature HIV particles.

Tipranavir (Aptivus)

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A nonpeptidic PI that inhibits HIV replication. Indicated for combination antiretroviral treatment in adults with HIV-1 infection who have evidence of viral replication and who are highly experienced with treatment or who have HIV-1 strains that are resistant to multiple PIs.

Tipranavir must be coadministered with ritonavir (200 mg) to attain therapeutic levels (ie, tipranavir/ritonavir). Administration alone, without ritonavir-boosted levels, is not effective. Genotypic or phenotypic testing and/or treatment history should guide use.

Antiretroviral agent, non-nucleoside reverse-transcriptase inhibitor

Class Summary

NNRTIs inhibit viral replication.

Delavirdine (Rescriptor)

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An NNRTI of HIV-1, delavirdine directly binds to reverse transcriptase and inhibits RNA- and DNA-dependent DNA polymerase.

Efavirenz (Sustiva)

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Efavirenz is an NNRTI with activity against HIV-1. This agent binds to reverse transcriptase and blocks RNA-dependent and DNA-dependent DNA polymerase activities, including HIV-1 replication. Efavirenz does not require intracellular phosphorylation for antiviral activity.

Etravirine (Intelence)

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Etravirine is an NNRTI of HIV-1 that binds directly to reverse transcriptase, causing catalytic site disruption. This action blocks RNA- and DNA-dependent DNA polymerase activities. Etravirine does not inhibit human DNA polymerases alpha, beta, or gamma.

This agent is indicated for use in combination with other antiretroviral agents for treatment-experienced HIV-infected adults who have viral replication and HIV-1 strains resistant to NNRTIs and other antiretroviral agents. If virologic failure was experienced with other NNRTIs, do not use etravirine in combination with NRTIs only.

Nevirapine (Viramune)

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Nevirapine is an NNRTI that limits virus replication by a mechanism different from the nucleosidase inhibitors such as zidovudine and lamivudine.

Rilpivirine (Edurant)

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Rilpivirine is a NNRTI that inhibits HIV-1 replication by noncompetitive inhibition of HIV-1 reverse transcriptase. It does not inhibit the human cellular DNA polymerases alpha, beta, and gamma.

Doravirine (Pifeltro)

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Indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults (1) who have not undergone antiretroviral therapy (ART) or (2) as a replacement for the current antiretroviral regimen in patients who are who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable ART regimen with no history of treatment failure and no known substitutions associated with resistance to doravirine.

Antiretroviral Agent, Integrase Inhibitor

Class Summary

This agent prevents insertion of a DNA copy of the viral genome into host cell DNA. It is indicated for HIV-1 infection combination therapy in treatment-experienced adults with evidence of viral replication and drug-resistant HIV-1 strains.

Raltegravir (Isentress)

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Raltegravir was the first available agent in the class of integrase strand transfer inhibitors.

Dolutegravir (Tivicay)

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Dolutegravir is an integrase strand transfer inhibitor (INSTI) that inhibits catalytic activity of HIV-1 integrase, an HIV encoded enzyme required for viral replication. It is approved for use in children 12 years or older who weigh at least 40 kg.

Elvitegravir (Vitekta)

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Integrase inhibitor that is used in combination with an HIV protease inhibitor (ie, atazanavir, lopinavir, darunavir, fosamprenavir, or tipranavir) and coadministered with ritonavir plus other antiretroviral drug(s) as indicated for the treatment of HIV-1 infection in antiretroviral treatment-experienced adults. It was originally approved as part of the combination product elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild).

Cabotegravir (Vocabria)

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Indicated in combination with rilpivirine PO as a complete regimen for short-term treatment of HIV-1 infection in adults who are virologically suppressed on a stable ART regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine. Specifically used as lead-in dosing for cabotegravir IM plus rilpivirine IM (Cabenuva) or for short-term replacement for planned missed Cabenuva injections.

Antiretroviral Agent, Fusion Inhibitor

Class Summary

These agents disrupt the ability of HIV to fuse with and infect healthy T cells.

Enfuvirtide (Fuzeon)

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This is the first agent in the new anti-HIV class called fusion inhibitors. Indicated for use in combination with other antiretroviral agents for HIV-1 infection in treatment-experienced patients who demonstrate evidence of HIV-1 replication despite ongoing antiretroviral therapy.

Enfuvirtide binds to HIV gp41 surface protein, thereby, disrupting the virus's ability to fuse with and infect healthy T cells. In clinical trials, subjects were twice as likely to achieve undetectable HIV-1 plasma levels (eg, < 40 copies/mL) when enfuvirtide was added to antiretroviral optimized regimens than without enfuvirtide added to therapy.

Antiretroviral agent, CCR5 antagonist

Class Summary

These agents block viral entry into white blood cells via the CCR5 co-receptor.

Maraviroc (Selzentry)

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Maraviroc blocks viral entry via the CCR5 co-receptor into WBCs, reduces viral load, and increases T-cell counts in infection with CCR5-tropic HIV-1 (ie, R5 virus). Accelerated approval by the US Food and Drug Administration (FDA) was based on 24-wk data. This agent is indicated for combination treatment with optimized background therapy in treatment-experienced adults infected with only R5 virus who have evidence of viral replication and have HIV-1 strains resistant to multiple antiretroviral agents.

HIV, Entry Inhibitors

Class Summary

Approval of ibalizumab was based on the MB-301 phase 3 trial. MB-301 was a single-arm, 24-week study of ibalizumab plus optimized background regimen (OBR) in treatment-experienced patients infected with multidrug-resistant HIV-1 virus.

The following study results were observed at 24 weeks: [166]

Among study participants, 43% achieved viral suppression < 50 copies/mL, and half achieved < 200 copies/mL.

While 60% of those with a baseline CD4 count of > 50 cells/µL achieved undetectable viral load, this fell to < 20% in those with lower CD4 counts.

Among participants, 55% had at least a 1 log decrease and 48% had at least a 2 log decrease in HIV RNA; the average reduction from baseline was 1.6 log.

The overall average CD4 cell gain was 48 cells/µL, but this differed according to baseline level; people who started with at least 50 cells/µL saw a mean gain of about 75 cells/µL, while those with lower baseline levels gained an average of 9 cells/µL.

Ibalizumab (Ibalizumab-uiyk, Trogarzo)

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CD4-directed post-attachment inhibitor that prevents viral entry and fusion within the CD4 cell. Ibalizumab does not inhibit HIV gp120 attachment to CD4; however, its postbinding conformational effects block the gp120-CD4 complex from interacting with CCR5 or CXCR4 and thus prevents viral entry and fusion while preserving normal immunological function. It is indicated for HIV-1 infection in heavily treated adults with multidrug-resistance. It is used in combination with the patient’s current ART regimen.

Complete Regimen Combinations

Class Summary

Complete fixed-dose regimens assist with medication adherence. Two-, three-, and four-drug combination products are available to decrease pill burden and administration frequency.

Cabotegravir/rilpivirine (Cabenuva)

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Cabotegravir IM plus rilpivirine IM are copackaged as a complete once monthly regimen for treatment of HIV-1 infection in adults to replace a current stable ART regimen in those who are virologically suppressed (HIV-1 RNA <50 copies/mL) with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine. The regimen starts after 30 days of an oral lead-in therapy with rilpivirine PO and cabotegravir PO.

Dolutegravir/rilpivirine (Juluca)

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First 2-drug, fixed-dose combination complete regimen approved for HIV infection. It is indicated for adults who are virologically suppressed (HIV-1 RNA < 50 copies/mL) and on a stable ART regimen for ≥ 6 months with no history of treatment failure and no known substitutions associated with resistance to dolutegravir or rilpivirine.

Dolutegravir/lamivudine (Dovato)

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First 2-drug, fixed-dose, complete regimen for treatment-naïve adults with HIV-1 infection with no known substitutions associated with resistance to dolutegravir or lamivudine. Combines integrase strand transfer inhibitor (INSTI) plus nucleoside reverse transcriptase inhibitor (NRTI).

Elvitegravir/cobicistat/emtricitabine/tenofovir AF (Genvoya)

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Antiretroviral combination product that provides a complete, once-daily regimen for treatment-naïve adults and adolescents aged ≥ 12 y, or to replace the current ART regimen in those who are virologically suppressed (HIV-1 RNA < 50 copies/mL) on a stable ART regimen for at least 6 months with no history of treatment failure. Each tablet contains an integrase inhibitor (elvitegravir 150 mg) and 2 NRTIs (emtricitabine 200 mg and tenofovir AF 10 mg). It also contains cobicistat, a CYP3A4 inhibitor used as a booster for elvitegravir, a CYP3A4 substrate.

Darunavir/cobicistat/emtricitabine/tenofovir AF (Symtuza)

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Complete regimen indicated for treatment of HIV-1 infection in adults and adolescents weighing at least 40 kg who have no prior antiretroviral (ART) treatment history or who are virologically suppressed (HIV-1 RNA < 50 copies/mL) on a stable ART regimen for at least 6 months and have no known substitutions associated with resistance to darunavir or tenofovir.

Emtricitabine/rilpivirine/tenofovir AF (Odefsey)

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Antiretroviral combination product that provides a complete, once-daily regimen for treatment-naïve adults and adolescents aged ≥ 12 y, or to replace the current ART regimen in those who are virologically suppressed (HIV-1 RNA < 50 copies/mL) on a stable ART regimen for at least 6 months with no history of treatment failure. Each tablet contains 1 NNRTI (rilpivirine 25 mg) and 2 NRTIs (emtricitabine 200 mg and tenofovir AF 25 mg).

Elvitegravir/cobicistat/emtricitabine/tenofovir DF (Stribild)

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Antiretroviral combination product that provides a complete, once-daily regimen for treatment-naïve adults. Contains an integrase inhibitor and 2 NRTIs plus cobicistat, a CYP3A4 inhibitor used as a booster for elvitegravir, a CYP3A4 substrate. Cobicistat enhances the systemic exposure of CYP3A substrates, such as elvitegravir, where bioavailability is limited and half-life is shortened by CYP3A-dependent metabolism.

Emtricitabine/rilpivirine/tenofovir DF (Complera)

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Complete regimen combination consisting of 2 NRTIs and 1 NNRTI. It is indicated for treatment of HIV-1 infection in patients aged ≥ 12 years with no antiretroviral treatment history and with HIV-1 RNA ≤ 100,000 copies/mL at the start of therapy, and in certain virologically-suppressed (HIV-1 RNA < 50 copies/mL) patients on a stable antiretroviral regimen at start of therapy in order to replace their current antiretroviral treatment regimen.

Bictegravir/emtricitabine/tenofovir AF (Biktarvy)

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Three-drug combination of bictegravir (BIC), an HIV-1 integrase strand transfer inhibitor (INSTI), and emtricitabine (FTC) and tenofovir alafenamide (TAF), both HIV-1 nucleoside analog reverse transcriptase inhibitors (NRTIs). Indicated as a complete regimen for treatment of HIV-1 infection in adults and pediatric patients weighing ≥25 kg who are ART-naïve or replacement of current antiretroviral regimen in patients who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral with no history of treatment failure and no known substitutions associated with resistance to the individual components.

Efavirenz/lamivudine/tenofovir DF (Symfi, Symfi Lo)

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Three-drug combination of a non-nucleoside reverse transcriptase inhibitor, and two nucleo(t)side reverse transcriptase inhibitors and is indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and children who weigh at least 35 kg (Symfi Lo) and 40 kg (Symfi).

Doravirine/lamivudine/tenofovir DF (Delstrigo)

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Indicated as a complete, once daily, regimen for treatment of HIV-1 infection in adults (1) who have not undergone antiretroviral therapy (ART) or (2) as a replacement for the current antiretroviral regimen in patients who are who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable ART regimen with no history of treatment failure and no known substitutions associated with resistance to the individual drug components.

Antiretroviral Combinations

Class Summary

Combination products are valuable to patient care and help ensure compliance.

Abacavir, lamivudine, zidovudine (Trizivir)

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Abacavir is a nucleoside reverse transcriptase inhibitor, which interferes with HIV viral RNA dependent DNA polymerase and inhibits viral replication. Lamivudine and zidovudine are thymidine analogs that inhibit viral replication.

Abacavir/lamivudine (Epzicom)

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This is a NRTI combination product. It is indicated in combination with other ART agents (eg, NNRTIs, PIs) for the treatment of HIV-1 infection in adults and pediatric patients aged 12 years or older. It is also indicated in combination with safer sex practices for preexposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in adults at high risk. This indication is based on clinical trials in men who have sex with men (MSM) at high risk for HIV-1 infection and in heterosexual serodiscordant couples. CDC guidelines include additional populations (eg, IV drug users, heterosexual individuals at high risk).

Abacavir/dolutegravir/lamivudine (Triumeq)

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Contains 2 NRTIs (abacavir 600 mg and lamivudine 300 mg) and an integrase strand inhibitor (dolutegravir 50 mg). Dosage modification may be required when coadministered with strong CYP3A4 inducers by adding a single-entity evening dose of dolutegravir.

Emtricitabine/tenofovir DF/efavirenz (Atripla)

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NRTI and NNRTI combination product.

Lamivudine/zidovudine (Combivir)

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NRTI combination product.

Emtricitabine/tenofovir DF (Truvada)

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NRTI combination product. Indicated in combination with other ART agents (eg, NNRTIs, PIs) for the treatment of HIV-1 infection in adults. It is also approved for pediatric patients who weigh at least 17 kg and can swallow the tablet whole. In addition, it is indicated in combination with safer sex practices for preexposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in adults and adolescents at high risk. This indication is based on clinical trials in men who have sex with men (MSM) at high risk for HIV-1 infection and in heterosexual serodiscordant couples. CDC guidelines include additional populations (eg, IV drug users, heterosexual individuals at high risk).

Emtricitabine/tenofovir AF (Descovy)

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NRTI combination product. Indicated in combination with other ART agents (eg, NNRTIs, PIs) for the treatment of HIV-1 infection in adults and pediatric patients aged 12 y or older. In addition, it is indicated for HIV-1 preexposure prophylaxis (PrEP) in at-risk adults and adolescents to reduce the risk of HIV-1 infection from sex, excluding those who have receptive vaginal sex.

Lamivudine/tenofovir DF (Cimduo)

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Combination contains 2 NRTIs (lamivudine 300 mg and tenofovir disoproxil fumarate 300 mg) and is indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and children who weigh at least 35 kg.

CYP3A4 Inhibitors

Class Summary

Boosting agents (eg, ritonavir, cobicistat) may be part of various ART drug regimens to inhibit metabolism of ART CYP3A substrates, resulting in increased systemic exposure and efficacy.

Cobicistat (Tybost)

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CYP3A inhibitor. As a single agent, it is indicated to increase systemic exposure of atazanavir or darunavir (once-daily dosing regimen) in combination with other antiretroviral agents. It was originally approved as part of the combination product elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild).

Antibiotic, Sulfonamide Derivative

Class Summary

Therapy should cover all likely pathogens in this clinical setting.

Sulfamethoxazole and Trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS, Sulfatrim)

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This combination inhibits bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid. This results in inhibition of bacterial growth.

Growth hormone releasing factor

Class Summary

This agent decreases visceral adipose tissue.

Tesamorelin (Egrifta)

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Tesamorelin is a growth hormone–releasing factor (GRF) analog indicated for reduction of excess abdominal fat in patients with HIV-associated lipodystrophy. This agent stimulates growth hormone production and increases serum levels of insulin-like growth factor–1 (IGF-1). It elicits anabolic and lipolytic actions.

HIV, Attachment Inhibitors

Class Summary

HIV-1 attachment inhibitors decrease viral replication by binding directly to the glycoprotein 120 (gp120) subunit on the surface of the virus.

Fostemsavir (Rukobia)

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Prodrug of temsavir, a first-in-class glycoprotein 120 (gp120) attachment inhibitor. Binds directly to the gp120 subunit on surface of the virus, thereby blocking HIV from attaching to host immune system CD4+ T cells and other immune cells. It is indicated in combination with other ATV drugs for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection failing their current ART regimen owing to resistance, intolerance, or safety considerations.

1. US Preventive Services Task Force., Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, et al. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Jun 18. 321 (23):2326-2336. [QxMD MEDLINE Link].

2. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [QxMD MEDLINE Link].

3. Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Owens DK. Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009 Jan 20. 150(2):125-31. [QxMD MEDLINE Link].

4. Centers for Disease Control and Prevention. Laboratory testing for the diagnosis of HIV infection : updated recommendations. Centers for Disease Control and Prevention. Available at ttps://stacks.cdc.gov/view/cdc/23447. June 27, 2014; Accessed: March 5, 2020.

5. World Health Organization (WHO). HIV/AIDS. World Health Organization (WHO). Available at //www.who.int/health-topics/hiv-aids/#tab=tab_1.

6. Reynolds SJ, Makumbi F, Newell K, et al. Effect of daily aciclovir on HIV disease progression in individuals in Rakai, Uganda, co-infected with HIV-1 and herpes simplex virus type 2: a randomised, double-blind placebo-controlled trial. Lancet Infect Dis. 2012 Jun. 12(6):441-8. [QxMD MEDLINE Link]. [Full Text].

7. [Guideline] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. October 17, 2017. U.S. Department of Health and Human Services. Available at //aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/0. December 18, 2019; Accessed: March 5, 2020.

8. US Food and Drug Administration. FDA approves first rapid diagnostic test to detect both HIV-1 antigen and HIV-1/2 antibodies. US Department of Health and Human Services, US Food and Drug Administration. Available at //www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm364480.htm. Accessed: August 12, 2013.

9. Lowes R. FDA OKs First Rapid Test for HIV-1/2 Antibodies, HIV-1 Antigen. Medscape [serial online]. Available at //www.medscape.com/viewarticle/809183. Accessed: August 15, 2013.

10. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992 Dec 18. 41:1-19. [QxMD MEDLINE Link].

11. [Guideline] AIDSInfo. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. AIDSInfo. Available at //aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. December 18, 2019; Accessed: January 24, 2020.

12. Talal AH, Monard S, Vesanen M, et al. Virologic and immunologic effect of antiretroviral therapy on HIV-1 in gut-associated lymphoid tissue. J Acquir Immune Defic Syndr. 2001 Jan 1. 26(1):1-7. [QxMD MEDLINE Link].

13. Guadalupe M, Reay E, Sankaran S, et al. Severe CD4+ T-cell depletion in gut lymphoid tissue during primary human immunodeficiency virus type 1 infection and substantial delay in restoration following highly active antiretroviral therapy. J Virol. 2003 Nov. 77(21):11708-17. [QxMD MEDLINE Link]. [Full Text].

14. Shacklett BL, Cox CA, Sandberg JK, Stollman NH, Jacobson MA, Nixon DF. Trafficking of human immunodeficiency virus type 1-specific CD8+ T cells to gut-associated lymphoid tissue during chronic infection. J Virol. 2003 May. 77(10):5621-31. [QxMD MEDLINE Link]. [Full Text].

15. Guadalupe M, Sankaran S, George MD, et al. Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection. J Virol. 2006 Aug. 80(16):8236-47. [QxMD MEDLINE Link]. [Full Text].

16. Re F, Braaten D, Franke EK, Luban J. Human immunodeficiency virus type 1 Vpr arrests the cell cycle in G2 by inhibiting the activation of p34cdc2-cyclin B. J Virol. 1995 Nov. 69(11):6859-64. [QxMD MEDLINE Link]. [Full Text].

17. Keating SM, Golub ET, Nowicki M, et al. The effect of HIV infection and HAART on inflammatory biomarkers in a population-based cohort of women. AIDS. 2011 Sep 24. 25(15):1823-32. [QxMD MEDLINE Link]. [Full Text].

18. Landires I, Bugault F, Lambotte O, et al. HIV infection perturbs interleukin-7 signaling at the step of STAT5 nuclear relocalization. AIDS. 2011 Sep 24. 25(15):1843-53. [QxMD MEDLINE Link].

19. Lederman MM. Immune restoration and CD4+ T-cell function with antiretroviral therapies. AIDS. 2001 Feb. 15 Suppl 2:S11-5. [QxMD MEDLINE Link].

20. Finkel TH, Tudor-Williams G, Banda NK, et al. Apoptosis occurs predominantly in bystander cells and not in productively infected cells of HIV- and SIV-infected lymph nodes. Nat Med. 1995 Feb. 1(2):129-34. [QxMD MEDLINE Link].

21. Liu R, Paxton WA, Choe S, et al. Homozygous defect in HIV-1 coreceptor accounts for resistance of some multiply-exposed individuals to HIV-1 infection. Cell. 1996 Aug 9. 86(3):367-77. [QxMD MEDLINE Link].

22. U.S. Department of Health and Human Services. AIDSInfo. AIDSInfo. Available at //aidsinfo.nih.gov/.

23. Jeffrey S. FDA approves first antidiarrheal drug for HIV/AIDS. Medscape Medical News. Dec 31, 2012. [Full Text].

24. Gao F, Bailes E, Robertson DL, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature. 1999 Feb 4. 397(6718):436-41. [QxMD MEDLINE Link].

25. Hirsch VM, Olmsted RA, Murphey-Corb M, Purcell RH, Johnson PR. An African primate lentivirus (SIVsm) closely related to HIV-2. Nature. 1989 Jun 1. 339(6223):389-92. [QxMD MEDLINE Link].

26. Popper SJ, Sarr AD, Gueye-Ndiaye A, Mboup S, Essex ME, Kanki PJ. Low plasma human immunodeficiency virus type 2 viral load is independent of proviral load: low virus production in vivo. J Virol. 2000 Feb. 74(3):1554-7. [QxMD MEDLINE Link]. [Full Text].

27. Popper SJ, Sarr AD, Travers KU, et al. Lower human immunodeficiency virus (HIV) type 2 viral load reflects the difference in pathogenicity of HIV-1 and HIV-2. J Infect Dis. 1999 Oct. 180(4):1116-21. [QxMD MEDLINE Link].

28. Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997 Jun 15. 126(12):946-54. [QxMD MEDLINE Link].

29. Rodríguez B, Sethi AK, Cheruvu VK, et al. Predictive value of plasma HIV RNA level on rate of CD4 T-cell decline in untreated HIV infection. JAMA. 2006 Sep 27. 296(12):1498-506. [QxMD MEDLINE Link].

30. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep. 1981 Jul 3. 30(25):305-8. [QxMD MEDLINE Link].

31. Barre-Sinoussi F, Chermann JC, Rey F, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983 May 20. 220(4599):868-71. [QxMD MEDLINE Link].

32. Ascher MS, Sheppard HW, Winkelstein W Jr, Vittinghoff E. Does drug use cause AIDS?. Nature. 1993 Mar 11. 362(6416):103-4. [QxMD MEDLINE Link].

33. Korber B, Muldoon M, Theiler J, et al. Timing the ancestor of the HIV-1 pandemic strains. Science. 2000 Jun 9. 288(5472):1789-96. [QxMD MEDLINE Link].

34. Koopman G, Haaksma AG, ten Velden J, Hack CE, Heeney JL. The relative resistance of HIV type 1-infected chimpanzees to AIDS correlates with the maintenance of follicular architecture and the absence of infiltration by CD8+ cytotoxic T lymphocytes. AIDS Res Hum Retroviruses. 1999 Mar 1. 15(4):365-73. [QxMD MEDLINE Link].

35. Birch MR, Learmont JC, Dyer WB, et al. An examination of signs of disease progression in survivors of the Sydney Blood Bank Cohort (SBBC). J Clin Virol. 2001 Oct. 22(3):263-70. [QxMD MEDLINE Link].

36. Dyer WB, Geczy AF, Kent SJ, et al. Lymphoproliferative immune function in the Sydney Blood Bank Cohort, infected with natural nef/long terminal repeat mutants, and in other long-term survivors of transfusion-acquired HIV-1 infection. AIDS. 1997 Nov. 11(13):1565-74. [QxMD MEDLINE Link].

37. Pantaleo G, Graziosi C, Fauci AS. New concepts in the immunopathogenesis of human immunodeficiency virus infection. N Engl J Med. 1993 Feb 4. 328(5):327-35. [QxMD MEDLINE Link].

38. Pantaleo G, Fauci AS. New concepts in the immunopathogenesis of HIV infection. Annu Rev Immunol. 1995. 13:487-512. [QxMD MEDLINE Link].

39. Weber J. The pathogenesis of HIV-1 infection. Br Med Bull. 2001. 58:61-72. [QxMD MEDLINE Link].

40. Frazer IH, Mackay IR, Crapper RM, et al. Immunological abnormalities in asymptomatic homosexual men: correlation with antibody to HTLV-III and sequential changes over two years. Q J Med. 1986 Oct. 61(234):921-33. [QxMD MEDLINE Link].

41. Schechter MT, Boyko WJ, Craib KJ, et al. Effects of long-term seropositivity to human immunodeficiency virus in a cohort of homosexual men. AIDS. 1987 Jul. 1(2):77-82. [QxMD MEDLINE Link].

42. Talal AH, Irwin CE, Dieterich DT, Yee H, Zhang L. Effect of HIV-1 infection on lymphocyte proliferation in gut-associated lymphoid tissue. J Acquir Immune Defic Syndr. 2001 Mar 1. 26(3):208-17. [QxMD MEDLINE Link].

43. Poles MA, Boscardin WJ, Elliott J, et al. Lack of decay of HIV-1 in gut-associated lymphoid tissue reservoirs in maximally suppressed individuals. J Acquir Immune Defic Syndr. 2006 Sep. 43(1):65-8. [QxMD MEDLINE Link].

44. van Marle G, Gill MJ, Kolodka D, McManus L, Grant T, Church DL. Compartmentalization of the gut viral reservoir in HIV-1 infected patients. Retrovirology. 2007 Dec 4. 4:87. [QxMD MEDLINE Link]. [Full Text].

45. Al-Harthi L, Marchetti G, Steffens CM, Poulin J, Sékaly R, Landay A. Detection of T cell receptor circles (TRECs) as biomarkers for de novo T cell synthesis using a quantitative polymerase chain reaction-enzyme linked immunosorbent assay (PCR-ELISA). J Immunol Methods. 2000 Apr 3. 237(1-2):187-97. [QxMD MEDLINE Link].

46. Hellerstein M, Hanley MB, Cesar D, et al. Directly measured kinetics of circulating T lymphocytes in normal and HIV-1-infected humans. Nat Med. 1999 Jan. 5(1):83-9. [QxMD MEDLINE Link].

47. Bandera A, Ferrario G, Saresella M, et al. CD4+ T cell depletion, immune activation and increased production of regulatory T cells in the thymus of HIV-infected individuals. PLoS One. 2010 May 24. 5(5):e10788. [QxMD MEDLINE Link]. [Full Text].

48. Franco JM, Rubio A, Martínez-Moya M, et al. T-cell repopulation and thymic volume in HIV-1-infected adult patients after highly active antiretroviral therapy. Blood. 2002 May 15. 99(10):3702-6. [QxMD MEDLINE Link].

49. Mohri H, Perelson AS, Tung K, et al. Increased turnover of T lymphocytes in HIV-1 infection and its reduction by antiretroviral therapy. J Exp Med. 2001 Nov 5. 194(9):1277-87. [QxMD MEDLINE Link]. [Full Text].

50. Bird JJ, Brown DR, Mullen AC, et al. Helper T cell differentiation is controlled by the cell cycle. Immunity. 1998 Aug. 9(2):229-37. [QxMD MEDLINE Link].

51. Samson M, Libert F, Doranz BJ, et al. Resistance to HIV-1 infection in caucasian individuals bearing mutant alleles of the CCR-5 chemokine receptor gene. Nature. 1996 Aug 22. 382(6593):722-5. [QxMD MEDLINE Link].

52. Poropatich K, Sullivan DJ Jr. Human immunodeficiency virus type 1 long-term non-progressors: the viral, genetic and immunological basis for disease non-progression. J Gen Virol. 2011 Feb. 92:247-68. [QxMD MEDLINE Link].

53. van der Ende ME, Schutten M, Raschdorff B, et al. CD4 T cells remain the major source of HIV-1 during end stage disease. AIDS. 1999 Jun 18. 13(9):1015-9. [QxMD MEDLINE Link].

54. Allers K, Hutter G, Hofmann J, et al. Evidence for the cure of HIV infection by CCR5?32/?32 stem cell transplantation. Blood. 2011 Mar 10. 117(10):2791-9. [QxMD MEDLINE Link].

55. Kostense S, Raaphorst FM, Notermans DW, et al. Diversity of the T-cell receptor BV repertoire in HIV-1-infected patients reflects the biphasic CD4+ T-cell repopulation kinetics during highly active antiretroviral therapy. AIDS. 1998 Dec 24. 12(18):F235-40. [QxMD MEDLINE Link].

56. McCune JM. The dynamics of CD4+ T-cell depletion in HIV disease. Nature. 2001 Apr 19. 410(6831):974-9. [QxMD MEDLINE Link].

57. Teixeira L, Valdez H, McCune JM, et al. Poor CD4 T cell restoration after suppression of HIV-1 replication may reflect lower thymic function. AIDS. 2001 Sep 28. 15(14):1749-56. [QxMD MEDLINE Link].

58. Pantaleo G, Graziosi C, Demarest JF, et al. HIV infection is active and progressive in lymphoid tissue during the clinically latent stage of disease. Nature. 1993 Mar 25. 362(6418):355-8. [QxMD MEDLINE Link].

59. Vago L, Antonacci MC, Cristina S, et al. Morphogenesis, evolution and prognostic significance of lymphatic tissue lesions in HIV infection. Appl Pathol. 1989. 7(5):298-309. [QxMD MEDLINE Link].

60. Edén A, Fuchs D, Hagberg L, et al. HIV-1 viral escape in cerebrospinal fluid of subjects on suppressive antiretroviral treatment. J Infect Dis. 2010 Dec 15. 202(12):1819-25. [QxMD MEDLINE Link]. [Full Text].

61. Karris MY, Anderson CM, Morris SR, Smith DM, Little SJ. Cost savings associated with testing of antibodies, antigens, and nucleic acids for diagnosis of acute HIV infection. J Clin Microbiol. 2012 Jun. 50(6):1874-8. [QxMD MEDLINE Link]. [Full Text].

62. Pruss D, Bushman FD, Wolffe AP. Human immunodeficiency virus integrase directs integration to sites of severe DNA distortion within the nucleosome core. Proc Natl Acad Sci U S A. 1994 Jun 21. 91(13):5913-7. [QxMD MEDLINE Link].

63. Schröder AR, Shinn P, Chen H, Berry C, Ecker JR, Bushman F. HIV-1 integration in the human genome favors active genes and local hotspots. Cell. 2002 Aug 23. 110(4):521-9. [QxMD MEDLINE Link].

64. Blankson JN, Persaud D, Siliciano RF. The challenge of viral reservoirs in HIV-1 infection. Annu Rev Med. 2002. 53:557-93. [QxMD MEDLINE Link].

65. Chun TW, Engel D, Berrey MM, Shea T, Corey L, Fauci AS. Early establishment of a pool of latently infected, resting CD4(+) T cells during primary HIV-1 infection. Proc Natl Acad Sci U S A. 1998 Jul 21. 95(15):8869-73. [QxMD MEDLINE Link].

66. Ho DD, Moudgil T, Alam M. Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med. 1989 Dec 14. 321(24):1621-5. [QxMD MEDLINE Link].

67. Saez-Cirion A, Lacabaratz C, Lambotte O, et al. HIV controllers exhibit potent CD8 T cell capacity to suppress HIV infection ex vivo and peculiar cytotoxic T lymphocyte activation phenotype. Proc Natl Acad Sci U S A. 2007 Apr 17. 104(16):6776-81. [QxMD MEDLINE Link]. [Full Text].

68. Kaul R, Plummer FA, Kimani J, et al. HIV-1-specific mucosal CD8+ lymphocyte responses in the cervix of HIV-1-resistant prostitutes in Nairobi. J Immunol. 2000 Feb 1. 164(3):1602-11. [QxMD MEDLINE Link].

69. Alimonti JB, Kimani J, Matu L, et al. Characterization of CD8 T-cell responses in HIV-1-exposed seronegative commercial sex workers from Nairobi, Kenya. Immunol Cell Biol. 2006 Oct. 84(5):482-5. [QxMD MEDLINE Link].

70. Alter G, Heckerman D, Schneidewind A, et al. HIV-1 adaptation to NK-cell-mediated immune pressure. Nature. 2011 Aug 3. 476(7358):96-100. [QxMD MEDLINE Link]. [Full Text].

71. Zoufaly A, an der Heiden M, Kollan C, et al. Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy. J Infect Dis. 2011 Feb 1. 203(3):364-71. [QxMD MEDLINE Link]. [Full Text].

72. Mills EJ, Bakanda C, Birungi J, Yaya S, Ford N. The prognostic value of baseline CD4 cell count beyond 6 months of antiretroviral therapy in HIV positive patients in Uganda. AIDS. 2012 Apr 21. [QxMD MEDLINE Link].

73. Ezeamama AE, Spiegelman D, Hertzmark E, et al. HIV infection and the incidence of malaria among HIV-exposed children from Tanzania. J Infect Dis. 2012 May 15. 205(10):1486-94. [QxMD MEDLINE Link]. [Full Text].

74. Lambert-Niclot S, Tubiana R, Beaudoux C, et al. Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma on a 2002-2011 survey. AIDS. 2012 May 15. 26(8):971-5. [QxMD MEDLINE Link].

75. Scherzer R, Estrella M, Li Y, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS. 2012 Apr 24. 26(7):867-75. [QxMD MEDLINE Link].

76. CDC. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Preliminary), Volume 30. CDC. Available at //www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-vol-30.pdf. November 2019; Accessed: March 5, 2020.

77. Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Preliminary). Available at //www.cdc.gov/hiv/topics/surveillance/resources/reports/. December 2018; Accessed: March 5, 2020.

78. Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men --- 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010 Sep 24. 59(37):1201-7. [QxMD MEDLINE Link].

79. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Available at //www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed: June 21, 2011.

80. Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. MMWR Morb Mortal Wkly Rep. 2012 Nov 30. 61(47):971-6. [QxMD MEDLINE Link]. [Full Text].

81. UNAIDS. Global AIDS update 2019 — Communities at the centre. UNAIDS. Available at //www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf. December 10, 2019; Accessed: March 5, 2020.

82. Ng M, Gakidou E, Levin-Rector A, Khera A, Murray CJ, Dandona L. Assessment of population-level effect of Avahan, an HIV-prevention initiative in India. Lancet. 2011 Nov 5. 378(9803):1643-52. [QxMD MEDLINE Link].

83. Greenhalgh H. Men With Same-Sex Partners 28 Times More Likely to Get HIV - U.N. Medscape News. Available at //www.medscape.com/viewarticle/899482. July 19, 2018; Accessed: July 24, 2018.

84. Creswell JD, Myers HF, Cole SW, Irwin MR. Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: a small randomized controlled trial. Brain Behav Immun. 2009 Feb. 23(2):184-8. [QxMD MEDLINE Link]. [Full Text].

85. Cao Y, Qin L, Zhang L, Safrit J, Ho DD. Virologic and immunologic characterization of long-term survivors of human immunodeficiency virus type 1 infection. N Engl J Med. 1995 Jan 26. 332(4):201-8. [QxMD MEDLINE Link].

86. Levy JA. HIV pathogenesis and long-term survival. AIDS. 1993 Nov. 7(11):1401-10. [QxMD MEDLINE Link].

87. Pantaleo G, Menzo S, Vaccarezza M, et al. Studies in subjects with long-term nonprogressive human immunodeficiency virus infection. N Engl J Med. 1995 Jan 26. 332(4):209-16. [QxMD MEDLINE Link].

88. Paroli M, Propato A, Accapezzato D, Francavilla V, Schiaffella E, Barnaba V. The immunology of HIV-infected long-term non-progressors--a current view. Immunol Lett. 2001 Nov 1. 79(1-2):127-9. [QxMD MEDLINE Link].

89. Nesheim SR, Kapogiannis BG, Soe MM, et al. Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, 1986-2004. Pediatrics. 2007 Jul. 120(1):100-9. [QxMD MEDLINE Link].

90. Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006 Sep 19. 145(6):397-406. [QxMD MEDLINE Link]. [Full Text].

91. Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006 Sep. 43(1):27-34. [QxMD MEDLINE Link].

92. Brooks M. Low Level HIV Viremia a Modifiable Risk Factor for Non-Hodgkin Lymphoma. Medscape Medical News. Available at //www.medscape.com/viewarticle/821277. Accessed: March 12, 2014.

93. Achenbach CJ, Buchanan AL, Cole SR, Hou L, Mugavero MJ, Crane HM, et al. HIV viremia and incidence of non-Hodgkin lymphoma in patients successfully treated with antiretroviral therapy. Clin Infect Dis. 2014 Feb 12. [QxMD MEDLINE Link].

94. [Guideline] Brooks M. New CDC HIV Testing Recommendations Offer Faster Diagnosis. Medscape Medical News. Jun 26 2014. [Full Text].

95. [Guideline] CDC. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Centers for Disease Control and Prevention. Available at //www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf. Accessed: Jul 7 2014.

96. Barclay L. ACOG Guidelines Recommend Repeat HIV Screening, Prophylaxis. Medscape Medical News. Available at //www.medscape.com/viewarticle/824112. Accessed: May 3, 2014.

97. [Guideline] Committee Opinion No 596: Routine Human Immunodeficiency Virus Screening. Obstet Gynecol. 2014 May. 123(5):1137-1139. [QxMD MEDLINE Link].

98. Skwarecki B. ACOG updates recommendations for prenatal HIV testing. Available at:. Medscape Medical News. WebMD Inc. Available at //www.medscape.com/viewarticle/845416. May 27, 2015;

99. [Guideline] American College of Obstetricians and Gynecologists. Committee opinion no: 635: prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015 Jun. 125 (6):1544-7. [QxMD MEDLINE Link].

100. Torian LV, Eavey JJ, Punsalang AP, et al. HIV type 2 in New York City, 2000-2008. Clin Infect Dis. 2010 Dec 1. 51(11):1334-42. [QxMD MEDLINE Link].

101. Claassen CW, Diener-West M, Mehta SH, Thomas DL, Kirk GD. Discordance Between CD4+ T-Lymphocyte Counts and Percentages in HIV-Infected Persons With Liver Fibrosis. Clin Infect Dis. 2012 Jun. 54(12):1806-13. [QxMD MEDLINE Link].

102. Detection of Acute HIV Infection in Two Evaluations of a New HIV Diagnostic Testing Algorithm - United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2013 Jun 21. 62(24):489-94. [QxMD MEDLINE Link].

103. Hull MW, Rollet K, Odueyungbo A, et al. Factors associated with discordance between absolute CD4 cell count and CD4 cell percentage in patients coinfected with HIV and hepatitis C virus. Clin Infect Dis. 2012 Jun. 54(12):1798-805. [QxMD MEDLINE Link].

104. Hoffmann CJ, Brown TT. Thyroid function abnormalities in HIV-infected patients. Clin Infect Dis. 2007 Aug 15. 45(4):488-94. [QxMD MEDLINE Link].

105. Lee PL, Yiannoutsos CT, Ernst T, et al. A multi-center 1H MRS study of the AIDS dementia complex: validation and preliminary analysis. J Magn Reson Imaging. 2003 Jun. 17(6):625-33. [QxMD MEDLINE Link].

106. Bucy RP, Hockett RD, Derdeyn CA, et al. Initial increase in blood CD4(+) lymphocytes after HIV antiretroviral therapy reflects redistribution from lymphoid tissues. J Clin Invest. 1999 May 15. 103(10):1391-8. [QxMD MEDLINE Link]. [Full Text].

107. Pakker NG, Notermans DW, de Boer RJ, et al. Biphasic kinetics of peripheral blood T cells after triple combination therapy in HIV-1 infection: a composite of redistribution and proliferation. Nat Med. 1998 Feb. 4(2):208-14. [QxMD MEDLINE Link].

108. Masia M, Padilla S, Alvarez D, et al. Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy. AIDS. 2013 Jan 14. 27(2):181-9. [QxMD MEDLINE Link].

109. Barclay L. HIV: guidelines stress role of primary care in management. Medscape Medical News. November 14, 2013. [Full Text].

110. Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2013 Nov 13. [QxMD MEDLINE Link].

111. Simard EP, Engels EA. Cancer as a cause of death among people with AIDS in the United States. Clin Infect Dis. 2010 Oct 15. 51(8):957-62. [QxMD MEDLINE Link]. [Full Text].

112. Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst. 2011 May 4. 103(9):753-62. [QxMD MEDLINE Link]. [Full Text].

113. Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C. Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. Clin Infect Dis. 2010 Oct 15. 51(8):947-56. [QxMD MEDLINE Link]. [Full Text].

114. Sterne JA, May M, Costagliola D, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009 Apr 18. 373(9672):1352-63. [QxMD MEDLINE Link]. [Full Text].

115. Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. 2010 Jul 15. 363(3):257-65. [QxMD MEDLINE Link].

116. Cain LE, Logan R, Robins JM, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study. Ann Intern Med. 2011 Apr 19. 154(8):509-15. [QxMD MEDLINE Link].

117. US Department of Health and Human Services. National Institutes of Health. NIH News. Starting Antiretroviral Therapy Earlier Yields Better Clinical Outcomes. June 8, 2009.

118. Hecht FM, Wang L, Collier A, et al. A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection. J Infect Dis. 2006 Sep 15. 194(6):725-33. [QxMD MEDLINE Link].

119. Hecht FM, Wellman R, Busch MP, et al. Identifying the early post-HIV antibody seroconversion period. J Infect Dis. 2011 Aug 15. 204(4):526-33. [QxMD MEDLINE Link]. [Full Text].

120. Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2018 Jul 24. 320 (4):379-396. [QxMD MEDLINE Link].

121. Rhee SY, Taylor J, Fessel WJ, et al. HIV-1 protease mutations and protease inhibitor cross-resistance. Antimicrob Agents Chemother. 2010 Oct. 54(10):4253-61. [QxMD MEDLINE Link]. [Full Text].

122. Lennox JL, DeJesus E, Lazzarin A, et al. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatment-naive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet. 2009 Sep 5. 374(9692):796-806. [QxMD MEDLINE Link].

123. Rockstroh JK, DeJesus E, Lennox JL, et al. Durable efficacy and safety of raltegravir versus efavirenz when combined with tenofovir/emtricitabine in treatment-naive HIV-1-infected patients: final 5-year results from STARTMRK. J Acquir Immune Defic Syndr. 2013 May 1. 63(1):77-85. [QxMD MEDLINE Link].

124. Raffi F, Rachlis A, Stellbrink HJ, Hardy WD, Torti C, Orkin C, et al. Once-daily dolutegravir versus raltegravir in antiretroviral-naive adults with HIV-1 infection: 48 week results from the randomised, double-blind, non-inferiority SPRING-2 study. Lancet. 2013 Mar 2. 381(9868):735-43. [QxMD MEDLINE Link].

125. Walmsley S, Antela A, Clumeck N, et al. Dolutegravir (DTG; S/GSK1349572) + Abacavir/Lamivudine Once Daily Statistically Superior to Tenofovir/Emtricitabine/Efavirenz: 48-Week Results - SINGLE (ING114467). Abstract presented at: 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Sept 2012. Abstract H-556b:

126. Cahn P, Pozniak AL, Mingrone H, Shuldyakov A, Brites C, Andrade-Villanueva JF, et al. Dolutegravir versus raltegravir in antiretroviral-experienced, integrase-inhibitor-naive adults with HIV: week 48 results from the randomised, double-blind, non-inferiority SAILING study. Lancet. 2013 Jul 2. [QxMD MEDLINE Link].

127. Nichols G, Mills A, Grossberg R, et al. Antiviral Activity of Dolutegravir in Subjects With Failure on an Integrase Inhibitor–Based Regimen: Week 24 Phase 3 Results From VIKING-3. Poster presented at: 11th International Congress on Drug Therapy in HIV Infection. Nov 2012. Poster O232:

128. Ndembi N, Goodall RL, Dunn DT, et al. Viral rebound and emergence of drug resistance in the absence of viral load testing: a randomized comparison between zidovudine-lamivudine plus Nevirapine and zidovudine-lamivudine plus Abacavir. J Infect Dis. 2010 Jan 1. 201(1):106-13. [QxMD MEDLINE Link].

129. Sax PE, DeJesus E, Mills A, et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks. Lancet. 2012 Jun 30. 379(9835):2439-48. [QxMD MEDLINE Link].

130. DeJesus E, Rockstroh JK, Henry K, et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate versus ritonavir-boosted atazanavir plus co-formulated emtricitabine and tenofovir disoproxil fumarate for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet. 2012 Jun 30. 379(9835):2429-38. [QxMD MEDLINE Link].

131. McMahon DK, Zheng L, Hitti J, Chan ES, Halvas EK, Hong F, et al. Greater Suppression of Nevirapine Resistance With 21- vs 7-Day Antiretroviral Regimens After Intrapartum Single-Dose Nevirapine for Prevention of Mother-to-Child Transmission of HIV. Clin Infect Dis. 2013 Apr. 56(7):1044-51. [QxMD MEDLINE Link]. [Full Text].

132. Spector SA, McKinley GF, Lalezari JP, et al. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1996 Jun 6. 334(23):1491-7. [QxMD MEDLINE Link].

133. Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries. Clin Infect Dis. 2012 May. 54(9):1364-72. [QxMD MEDLINE Link].

134. Falutz J, Potvin D, Mamputu JC, et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010 Mar 1. 53(3):311-22. [QxMD MEDLINE Link].

135. Falutz J, Allas S, Blot K, Potvin D, Kotler D, Somero M, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007 Dec 6. 357(23):2359-70. [QxMD MEDLINE Link].

136. Falutz J, Mamputu JC, Potvin D, Moyle G, Soulban G, Loughrey H, et al. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab. 2010 Sep. 95(9):4291-304. [QxMD MEDLINE Link].

137. Stanley TL, Falutz J, Marsolais C, et al. Reduction in visceral adiposity is associated with an improved metabolic profile in HIV-infected patients receiving tesamorelin. Clin Infect Dis. 2012 Jun. 54(11):1642-51. [QxMD MEDLINE Link]. [Full Text].

138. Lingappa JR, Baeten JM, Wald A, Hughes JP, Thomas KK, Mujugira A, et al. Daily acyclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial. Lancet. 2010 Mar 6. 375(9717):824-33. [QxMD MEDLINE Link]. [Full Text].

139. Ruel TD, Boivin MJ, Boal HE, et al. Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts. Clin Infect Dis. 2012 Apr. 54(7):1001-9. [QxMD MEDLINE Link]. [Full Text].

140. Gaps in HIV Testing and Treatment Hinder Efforts to Stop New Infections. CDC. Available at //www.cdc.gov/media/releases/2019/p0315-gaps-hinder-hiv-testing.html. March 18, 2019; Accessed: March 20, 2019.

141. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2011 Oct 3. [QxMD MEDLINE Link].

142. Marazzi MC, Palombi L, Nielsen-Saines K, et al. Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes. AIDS. 2011 Aug 24. 25(13):1611-8. [QxMD MEDLINE Link].

143. Burgard M, Jasseron C, Matheron S, et al. Mother-to-child transmission of HIV-2 infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1. Clin Infect Dis. 2010 Oct 1. 51(7):833-43. [QxMD MEDLINE Link].

144. Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009 Dec 3. 361(23):2209-20. [QxMD MEDLINE Link].

145. Robb ML, Rerks-Ngarm S, Nitayaphan S, et al. Risk behaviour and time as covariates for efficacy of the HIV vaccine regimen ALVAC-HIV (vCP1521) and AIDSVAX B/E: a post-hoc analysis of the Thai phase 3 efficacy trial RV 144. Lancet Infect Dis. 2012 Jul. 12(7):531-7. [QxMD MEDLINE Link]. [Full Text].

146. Brooks M. CDC updates HIV preexposure prophylaxis guidelines. Medscape Medical News. May 14, 2014. [Full Text].

147. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 Clinical Practice Guideline. Centers for Disease Control and Prevention. May 2014. Available at //www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.

148. Descovy (emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences. October, 2019. Available at [Full Text].

149. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30. 363(27):2587-99. [QxMD MEDLINE Link]. [Full Text].

150. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11. 365(6):493-505. [QxMD MEDLINE Link]. [Full Text].

151. Choopanya K, Martin M, Suntharasam P, Sangkum U, Mock P, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomized, double-blind, placebo-controlled phase 3 trial. Lancet. 2013. 2083-90.

152. Leibowitz AA, Parker KB, Rotheram-Borus MJ. A US Policy Perspective on Oral Preexposure Prophylaxis for HIV. Am J Public Health. 2011 Jun. 101(6):982-5. [QxMD MEDLINE Link].

153. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011 Jan 28. 60(3):65-8. [QxMD MEDLINE Link].

154. Centers for Disease Control and Prevention. Last updated February 22, 2011. HIV/AIDS - Pre-Exposure Prophylaxis (PrEP). [Full Text].

155. [Guideline] Marrazzo JM, del Rio C, Holtgrave DR, et al, for the International Antiviral Society-USA Panel. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312(4):390-409. [QxMD MEDLINE Link]. [Full Text].

156. Smith M. Antiviral group: 'Biomedical' tx could slow HIV. MedPage Today. July 21, 2014. [Full Text].

157. [Guideline] Günthard HF, Aberg JA, Eron JJ, for the International Antiviral Society-USA Panel. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312(4):410-25. [QxMD MEDLINE Link]. [Full Text].

158. [Guideline] DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, et al. Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017 Aug 11. 66 (31):830-832. [QxMD MEDLINE Link].

159. EACS. European AIDS Clinical Society Guidelines Version 10.0. European AIDS Clinical Society. Available at //www.eacsociety.org/files/2019_guidelines-10.0_final.pdf. November 2019; Accessed: December 2, 2019.

160. [Guideline] US DHHS. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. U.S. Department of Health and Human Services. Available at //aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/0. December 18, 2019; Accessed: August 20, 2020.

161. Mounzer K, Palella F, Slim J, et al. SPIRIT: Simplifying to rilpivirine/emtricitabine/tenofovir Df single-tablet regimen from boosted protease inhibitor regimen maintains HIV suppression in the black subgroup [abstract H-656]. Presented at: The 53rd Interscience Conference onAntimicrobial Agents and Chemotherapy (ICAAC); September 11, 2013; Denver, Colorado. [Full Text].

162. Kling J. Single-tablet HIV regimen effective. Medscape Medical News. September 19, 2013. [Full Text].

163. Tucker ME. FDA OKs New Triple-Combination Pill (Triumeq) for HIV. Medscape Medical News. Aug 22 2014. [Full Text].

164. Molina JM, Squires K, Sax PE, Cahn P, Lombaard J, DeJesus E, et al. Doravirine versus ritonavir-boosted darunavir in antiretroviral-naive adults with HIV-1 (DRIVE-FORWARD): 48-week results of a randomised, double-blind, phase 3, non-inferiority trial. Lancet HIV. 2018 May. 5 (5):e211-e220. [QxMD MEDLINE Link].

165. Orkin C, Squires KE, Molina JM, Sax PE, Wong WW, Sussmann O, et al. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate is Non-inferior to Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate in Treatment-naive Adults With Human Immunodeficiency Virus-1 Infection: Week 48 Results of the DRIVE-AHEAD Trial. Clin Infect Dis. 2018 Aug 31. [QxMD MEDLINE Link].

166. Lewis S, Fessel J, Emu B, Schrader S, Kumar P, Richmond GJ, et al. Long-acting ibalizumab in patients with multi-drug resistant HIV-1: A 24-week study. Presented at the 2017 Conference on Retroviruses and Opportunistic Infections. February 13-16, 2017. Seattle, WA. Abstracts from the 2017 Conference on Retroviruses and Opportunistic Infections. February 13-16, 2017. Seattle, Washington. Top Antivir Med. 2017 Apr. 25 (1s):4s-446s. [QxMD MEDLINE Link]. [Full Text].

Author

Shelley A Gilroy, MD, FACP, FIDSA Associate Professor of Medicine, Infectious Disease and HIV Medicine, Albany Medical College; Associate Chief of Staff for Education/DEO, Lead Physician for HIV Medicine, Division of Infectious Diseases, Albany Stratton VA Medical Center

Shelley A Gilroy, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

John J Faragon, PharmD, BCPS, AAHIVP Pharmacist, HIV/HCV Medicine, Division of HIV Medicine and Department of Pharmacy, Albany Medical Center; Regional Pharmacy Director, Northeast Caribbean AIDS Education and Training Center; HIV and HCV Education Consultant, VirologyEd Consultants

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Gilead; Janssen; Merck.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Acknowledgements

Aaron Glatt, MD Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society forHealthcare Epidemiology of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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