Date: January 24, 2022

Updates to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV

The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) updated the following sections of the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Highlights are summarized below:

Early (Acute and Recent) HIV Infection

  • In the previous version of the guidelines, the Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) suggested that an HIV RNA level of <10,000 copies/mL in a person suspected to have acute HIV may represent a false-positive test result. The section was updated to revise this threshold. The Panel noted that given the improved sensitivity and specificity of current HIV RNA tests in the presence of compatible symptoms or exposure history, even a low HIV RNA concentration (e.g., <3,000 copies/mL) in the setting of a negative or indeterminate HIV antibody test result may represent acute HIV. The Panel noted that, in rare cases, an HIV RNA <3,000 copies/mL may represent a false-positive quantitative test result. In that case, repeat testing should be done to confirm the diagnosis.
  • In this revision, the Panel also provided updated information regarding diagnosis of acute HIV in individuals who are receiving pre-exposure prophylaxis and subsequent initiation of antiretroviral therapy (ART).

Discontinuation or Interruption of Antiretroviral Therapy

  • This section has been updated to include discussions regarding discontinuation or interruption of long-acting antiretroviral drugs, including ibalizumab and the intramuscular formulations of cabotegravir and rilpivirine. The section also includes discussions regarding steps to take before and during ART interruption for people with HIV who participate in clinical trials that involve analytical treatment interruptions.

For a complete list of updates, please see What's New in the Guidelines. To view or download the guidelines, please see the Adult and Adolescent ARV Guidelines section of Clinical Info’s website. The guidelines tables and recommendations can also be downloaded as separate PDF files.

Clinical Info Welcomes Your Feedback on the latest revisions to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Please send your comments with the subject line “Adult and Adolescent ARV Guidelines” to HIVinfo@NIH.gov by February 10, 2022.