What Is the Treatment of Acquired Immunodeficiency Syndrome? First-Line Antiretroviral Therapy
For individuals newly diagnosed with Acquired immunodeficiency syndrome (AIDS), prompt initiation of treatment is central to management. This page summarises the first-line treatment approach, key clinical goals, and what the structured evidence-based regimen addresses.
Antiretroviral therapy should be started as soon as possible after diagnosis; recommended first-line regimens draw from a specific class of agents selected for high viral suppression rates, strong tolerability, and a high barrier to resistance — with the choice between available options guided by individual clinical factors.
HIV RNA should fall below 200 copies/mL within 12–24 weeks of starting therapy, with the ongoing target being sustained virologic suppression below 50 copies/mL.
References
DOI: 10.1001/jama.2024.24543
Regimens composed of the integrase strand transfer inhibitors (InSTIs) bictegravir (BIC) or dolutegravir (DTG) are recommended as initial treatment for most people with HIV due to high viral suppression rates, excellent tolerability, infrequent toxicity, limited drug-drug interactions, a high barrier to resistance, and a low pill burden (evidence rating: AIa).
Initiation of ART is recommended as soon as possible after diagnosis, ideally within 7 days, including on the same day as diagnosis or at the first clinic visit if the individual is ready and there is no suspicion for a concomitant opportunistic infection (evidence rating: AIII).
A genotype based on the person's regimen is advised if, after 12 to 24 weeks of therapy, HIV RNA levels have not decreased to below 200 copies/mL and adherence seems adequate (evidence rating: AIIa).
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