Acquired immunodeficiency syndrome
ICD-10 B20; B24 · ICD-11 1C62.3

First-Line Treatment of Acquired Immunodeficiency Syndrome

This protocol addresses the initiation of antiretroviral treatment in adults and adolescents newly diagnosed with HIV/AIDS. It defines the recommended drug class backbone, conditions that govern which regimen applies, and the measurable goals used to assess response.

Treatment Approach

Current guidelines recommend initiating combination antiretroviral therapy built around an oral second-generation integrase strand transfer inhibitor (INSTI). The specific regimen options, eligibility conditions, and any applicable restrictions are outlined in full in the structured protocol.

Full regimen details, agent selection, and criteria available via the protocol below.

Clinical Goals

The primary treatment targets are suppression of plasma HIV RNA to below 200 copies/mL — generally to below the limit of assay detection — by approximately 8 to 12 weeks after initiation, and a meaningful increase in CD4 T lymphocyte cell count over the first year of therapy.

Instant Access to Structured Evidence-Based Regimens

References

  • The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) now recommends initial ARV regimens based on an oral second-generation INSTI plus two NRTIs—bictegravir (BIC)/tenofovir alafenamide (TAF)/emtricitabine (FTC) (AI) or dolutegravir (DTG) plus TAF/FTC or tenofovir disoproxil fumarate (TDF)/FTC or TDF/lamivudine (3TC) (AI)—for most people with HIV.
  • In some people with HIV, the two-drug regimen DTG/3TC can be used (AI).
  • DTG/3TC (AI), except for individuals with HIV RNA >500,000 copies/mL, HBV coinfection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.
  • Individuals who are adherent to their ARV regimens and do not harbor resistance mutations to the component drugs can generally achieve viral suppression 8 to 12 weeks after ART initiation or after modification due to virologic failure; rarely, it may take longer in some people.
  • For most people, an adequate response is defined as an increase in CD4 count in the range of 50 cells/mm3 to 150 cells/mm3 in the first year of ART, generally with an accelerated response in the first 3 months of treatment.
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