The Department of Health and Human Services is a federal agency that protects the health of the American public.

The DHHS HIV guidelines help inform healthcare professionals of the best ways to treat HIV based on the latest clinical evidence and expert opinions.

We break down some of the key points of the DHHS guidelines and what to know about the most recent changes.

The DHHS guidelines aim to give recommendations to healthcare professionals on the best treatment options for people with HIV. The guidelines are updated based on the most recent scientific evidence.

Doctors and healthcare professionals can consult these guidelines to determine the right treatment at various stages of HIV. For example, the guidelines provide recommendations on when to start antiretroviral therapy (ART), which drugs should be used, and what to do if initial treatment isn’t working.

The full guidelines provide a long list of recommendations you can read here. We’ve summarized some key points below so you can get an idea of the type of information these guidelines include.

Drugs when starting treatment

  • ART is recommended for people with HIV to reduce their risk of death and illness.
  • ART should be started by people with a new diagnosis of HIV.
  • Potential drug resistance can be detected with genetic testing at the beginning of treatment.
  • Medical professionals should discuss future pregnancy plans with people who are able to become pregnant. A pregnancy test may be performed before starting HIV treatment.

Preventing sexual transmission

  • People with HIV should be told that keeping their plasma The HIV viral load is high. under 200 copies per milliliter (mL) prevents sexual transmission of HIV.
  • For at least the first 6 months of treatment, people starting ART should use a barrier method, such as a condom, until they have a viral load under 200 copies per mL.
  • If the person has a high viral load, a barrier method should be used.
  • People should be told that keeping a viral load under 200 copies per mL doesn’t stop the transmission of other sexually transmitted infections.

Types of drugs

Initial HIV treatment generally consists of two medications called nucleoside reverse transcriptase inhibitors in combination with a third active antiretroviral (ARV) drug from one of three drug classes:

  1. The strand transfer inhibitors are in the works.
  2. Nonnucleoside reverse transcriptases are used.
  3. protease inhibitors with a pharmacokinetic enhancer

The following drug regimens are classified as “recommended initial regimens for most people with HIV.” A slash (/) between medications means they’re available as a combination drug within the same pill:

  • Bictegravir/tenofovir/emtricitabine is a drug.
  • dolutegravir/abacavir/lamivudine in people without the HLA-B*5701 gene and without chronic hepatitis B infection
  • Dolutegravir and either emtricitabine or lamivudine.
  • If ART is started before receiving genetic testing results, dolutegravir/lamivudine is not suitable for people with a viral load greater than 500,000 copies per mL.

Treatment failure

“Several factors should be considered when ART isn’t working.”

  • Drug-drug interactions.
  • Drug-food interactions.
  • “Drug’s effect on the body”
  • The HIV viral load is high.
  • The count of CD4 cells.
  • ART history.
  • Drug resistance tests results.
  • Staying with a treatment plan.

Specific patient groups

  • ART is recommended for adolescents and young adults to lower the chances of death and disease.
  • All people who are trans are recommended to use ART.
  • “Older adults have a higher risk of non-AIDS complications and don’t respond as well to ART as younger people.”
  • Substance use disorders are common among people with HIV and can contribute to poor outcomes. Screening should be a regular part of care. The most common substances to screen for include:
    • Alcohol.
    • The drug benzodiazepines.
    • It is cannabis.
    • The drugs that are opioids.
    • cocaine
    • methamphetamines
    • tobacco

Women

  • When prescribing ARV drugs to women, healthcare professionals should consider that some ARV drugs interact with hormonal birth control.
  • This group can gain weight. If healthcare professionals are concerned about the issue of Obesity, they should consider it in the treatment choice.

At the time this article was written, the DHHS guidelines were most recently updated on January 20, 2022.

Researchers are trying to improve their understanding of how to treat HIV. The guidelines are updated frequently to include the latest research.

The most recent changes are listed here.

Early HIV

The guidelines regarding false-positive test results have been updated. The Panel on Antiretroviral Guidelines for Adults and Adolescents explained in the previous version that a person with an HIV RNA level of less than 10,000 copies/mL may be positive for HIV.

The panel updated their information to say that HIV tests are very specific and sensitive in people who have been exposed to the virus. A low HIV RNA concentration of less than 3000 copies/mL could still be acute HIV even if it is negative or not.

In rare cases, an HIV test may have a concentration of less than 3000 copies/mL and show up as a false positive.

It is important that repeat testing is done in these situations to make sure a person is receiving the correct diagnosis.

The section describing acute HIV diagnoses among people who are receiving pre-exposure prophylactic followed by ART has been updated.

Discontinued or interrupted ART

The guidelines now include information on the interruption of long-acting ART, such as ibalizumab and the cabotegravir and rilpivirine.

The update explains the steps that need to be taken before and during ART interruption for people who have HIV and are participating in a clinical trial.

There are many programs that help people with HIV. Some resources may be helpful.

The DHHS HIV guidelines were developed to help healthcare professionals stay up to date with the latest HIV research so they can provide the best possible treatment. As new research or evidence becomes available, the guidelines are updated regularly.

The guidelines are available online for free to anybody who wants to read them.