What's New in the Guidelines

Updated Reviewed

December 06, 2023

The HIV-2 Infection section of the guidelines has been updated with the following key information:

  • Because HIV-2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors, the long-acting injectable regimen of cabotegravir (CAB) and rilpivirine is not recommended for people with HIV-2 (AIII).
  • Limited data showed that HIV-2 also is resistant to fostemsavir; therefore, this drug should not be used in people with HIV-2 (AIII).
  • For patients with multidrug-resistant virus, ibalizumab and lenacapavir demonstrate in vitro potency against HIV-2 and may be considered (BIII).
  • A new clinical trial on the use of dolutegravir has been added to support the use of integrase strand transfer inhibitors (INSTIs) for people with HIV-2.
  • The Panel noted that when available, some clinicians prefer using boosted darunavir (DRV) over lopinavir/ritonavir for treatment of HIV-2 infection because DRV is better tolerated.

The Early (Acute and Recent) HIV Infection section has been updated to include an extended analysis from the HPTN 083 study, which evaluated the role of long-acting CAB (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV. This analysis reported on cases of HIV in the CAB-LA arm (some of which occurred despite on-time CAB injections), delays in HIV diagnosis, and the identification of major INSTI-resistance mutations. These results reinforce the importance of screening for INSTI-resistance mutations prior to initiation of an INSTI regimen in a person with a history of CAB-LA used for PrEP and a diagnosis of HIV.

 

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