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

Treatment of AIDS When Oral Antiretroviral Therapy Cannot Be Taken Consistently

Patients with Acquired immunodeficiency syndrome who are unable to maintain consistent oral antiretroviral therapy despite extensive clinical efforts, and who have advanced disease markers or a history of AIDS-defining complications, present a specific management challenge addressed by a distinct evidence-supported protocol.
Clinical Criteria for This Scenario
Treatment Approach

When all of the above criteria are met and no other treatment options are effective, an injectable long-acting antiretroviral regimen, delivered alongside intensive case management and adherence support, is an evidence-supported approach — the complete protocol specifies the full eligibility requirements, schedule, and administration details.

Goal: Achieve and maintain virologic control
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1001/jama.2024.24543

Injectable long-acting cabotegravir plus long-acting rilpivirine in conjunction with intensive case management and adherence support may be considered for people with viremia who meet the criteria below when no other treatment options are effective (AIIa under the conditions described):

— Unable to take oral ART consistently despite extensive efforts and clinical support

— High risk of HIV disease progression (CD4+ cell count <200/μL or history of AIDS-defining complications)

— A virus susceptible to both cabotegravir and rilpivirine

Some clinical programs have reported success in caring for such individuals using injectable long-acting cabotegravir plus long-acting rilpivirine every 4 weeks initially (and subsequently every 8 weeks), in conjunction with intensive case management services, as a way to achieve and maintain virologic control.

For those unable to take oral ART with advanced HIV disease, long-acting cabotegravir plus long-acting rilpivirine in conjunction with intensive case management and adherence support may be considered for people with viremia who meet the criteria below when no other treatment options are effective (evidence rating: AIIa under the conditions described).

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