What's New in the Guidelines

Updated Reviewed

September 24, 2026

The Panel for the Use of Antiretroviral Agents in Adults and Adolescents With HIV (the Panel) has updated the guidelines on the use of antiretroviral therapy (ART) for the treatment of people with HIV.

Note: In August 2026, the U.S. Food and Drug Administration approved bictegravir/lenacapavir (Bixlenvo) for the treatment of HIV. The Panel is reviewing the available information, which will be addressed in a future update.

Sections Added to the Guidelines

Principles of Antiretroviral Therapy

A new section on the Principles of Antiretroviral Therapy has been added to outline the core principles to consider when selecting antiretroviral (ARV) regimens for the treatment of HIV and how to apply these principles in the context of initial therapy, regimen optimization, or virologic failure.

Knowledge Gaps

A new subsection of key “Knowledge Gaps” has been added to the end of select revised sections of the guidelines.

Content Removed From the Guidelines

The guidelines previously included tables outlining select drug–drug interactions associated with ARV medications; however, the Panel now refers readers to the Liverpool HIV Drug Interaction Checker for formal drug–drug interaction guidance. The last versions of the drug–drug interaction tables remain available in the Archived Guidelines. The remaining Drug–Drug Interactions section has been updated to include pharmacokinetic mechanisms related to islatravir drug interactions and a new section on drug–drug interactions with long-acting ARV medications.

Key Revisions to the Guidelines

What to Start

Updates made to the What to Start chapter include the following:

Optimizing Antiretroviral Therapy in the Setting of Viral Suppression

Updates made to the Optimizing Antiretroviral Therapy in the Setting of Viral Suppression section include the following:

  • The Panel provided a list of ARV drugs that are not recommended for regimen optimization in the setting of viral suppression due to factors such as serious adverse effects, high pill burden, or low barrier to resistance.
  • Expanded discussion on considerations for hepatitis B and HIV when prescribing ARV regimens that do not include tenofovir.
  • Added the two-drug ARV regimen doravirine (DOR)/islatravir (ISL) as an optimization strategy for people with ongoing viral suppression and no history of prior virologic failure or resistance to DOR or ISL.
  • Added new guidance noting that DTG/3TC or a boosted protease inhibitor plus 3TC or FTC are not recommended as switch strategies for people with historical M184V/I mutations.

Interruption of Antiretroviral Therapy

Formerly titled Discontinuation or Interruption of Antiretroviral Therapy, the Interruption of Antiretroviral Therapy section was renamed to reflect the importance of ART continuity. Additional updates include the following:

  • Expanded discussion regarding considerations for interruptions of oral ART, long-acting (LA) injectable ART, and regimens containing both oral and LA ARVs.

Adolescents and Young Adults With HIV

Updates made to the Adolescents and Young Adults With HIV section include the following:

  • Expanded discussion of differences between the management of people with perinatally and non–perinatally acquired HIV, as well as factors that affect HIV care outcomes.
  • Expanded discussion on factors (e.g., developmental changes, mental health, substance use, unstable housing, trauma) that are faced by some adolescents and young adults (AYA), as well as the importance of addressing these factors to improve engagement in care and treatment success.
  • Added discussion of population-specific adherence strategies, LA ART, treatment considerations for AYA with drug resistance, and transitions from pediatric to adult care.

Substance Use Disorders and HIV

Updates made to the Substance Use Disorders and HIV section include the following:

  • Added discussion emphasizing the importance of routine screening for substance use disorders and co-occurring mental health disorders and that ongoing substance use is not a contraindication to ART.
  • Expanded discussion of polysubstance use, chemsex, unstable housing, opioid adulterants, and other factors that affect HIV care outcomes.
  • Added discussion of LA ART for people with substance use disorders and updated the table on Medications for Treatment of Substance Use Disorders.
  • Added discussion of medetomidine, an adulterant added to illicit opioids that has led to an outbreak of overdoses. Medetomidine is a CYP3A, 2D, and 2E substrate that may interact with some ARV drugs.

Women With HIV

Updates made to the Women With HIV section include the following:

  • Updated published data on the use of LA CAB/RPV during pregnancy and provided guidance on strategies and viral load monitoring if LA CAB/RPV is used during pregnancy.
  • Added discussion on ART use and infant feeding options postpartum for women of reproductive potential as recommended by the Perinatal Guidelines.
  • Added discussion on special considerations for menopause and comorbidities in the context of HIV care.

Hepatitis B Virus (HBV)/HIV Coinfection

Updates to the HBV/HIV Coinfection section include the following:

  • Added recommendation that people with HIV and chronic HBV should be tested for hepatitis D virus infection.
  • Clarified that, in certain situations, tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) alone (without 3TC or FTC) can be used as the only drug with HBV activity; TAF or TDF alone for HBV treatment should be used in combination with an effective ARV regimen.
  • Highlighted that ISL-containing ARV regimens are contraindicated with 3TC and FTC.
  • Expanded discussion and recommendations on HBV-specific considerations when initiating or transitioning to tenofovir-sparing ART.

Cost Considerations and Antiretroviral Therapy

Updates made to the Cost Considerations and Antiretroviral Therapy section include the following:

  • Added recommendations on assessing and addressing cost-related barriers to ART while ensuring that cost-driven regimen changes do not compromise virologic efficacy.
  • Expanded discussion of coverage changes, payer-driven barriers, Medicare coverage, generic and hybrid ART options, LA ART costs, 340B, and Ryan White HIV/AIDS Program supports.
  • Added two new tables with cash-pay estimates for recommended initial and optimization ART regimens (Tables 22a and 22b), including generic and hybrid options, and updated Table 22c to include National Average Drug Acquisition Cost benchmarks alongside Wholesale Acquisition Cost and Average Wholesale Price for individual ARV agents, coformulations, and single-tablet regimens.

Other Updates

Minor updates have been made throughout the following sections of the guidelines:

May 27, 2026

In March 2026, the American College of Cardiology (ACC)/American Heart Association(AHA)/Multisociety published an updated Dyslipidemia Management Guideline, which includes new recommendations specifically for people with HIV. Given that the new recommendations for statin therapy in people with HIV were developed by experts in dyslipidemia management, the Panel will retire its Statin Therapy as Primary Prevention of Atherosclerotic Cardiovascular Disease in People With HIV section and defer to the ACC/AHA/Multisociety Dyslipidemia Management Guideline for statin guidance. The Panel will provide further considerations on the role of statins and other strategies for primary prevention of atherosclerotic cardiovascular disease for people with HIV as part of a future update of the Cardiovascular Complications section of the Guidelines. Until this update occurs, an overview of statin therapy recommendations relevant to people with HIV is available in the Update on Statin Therapy as Primary Prevention of Atherosclerotic Cardiovascular Disease in People With HIV section.

Download Guidelines

Related Content