A patient presenting with acute HIV infection who has received long-acting injectable cabotegravir (CAB LA) for pre-exposure prophylaxis (PrEP) within the preceding 14 months requires specific clinical consideration when selecting antiretroviral therapy.
When HIV acquisition occurs during or after recently discontinuing CAB LA PrEP, there is a potential risk of selecting for cabotegravir and other integrase strand transfer inhibitor (INSTI) resistance — a factor that directly shapes the choice of initial antiretroviral regimen.
Consultation with an experienced HIV care provider is recommended; the approach involves a non-INSTI-based regimen — a boosted protease inhibitor combined with two NRTIs — initiated while resistance testing results are awaited.
Suppression of plasma HIV RNA to below detectable levels; a viral load test 4 weeks after starting antiretroviral therapy confirms the response to treatment.
For individuals who acquire HIV while receiving or after recently discontinuing long-acting injectable cabotegravir (CAB LA) as PrEP, there is a potential risk of selection of CAB and other INSTI resistance.
For such patients, the initial regimen should consist of a non-INSTI-based regimen (e.g., a boosted protease inhibitor and 2 NRTIs) while awaiting resistance test results.
The clinicians should implement treatment to suppress the patient's plasma HIV RNA to below detectable levels.
Clinicians should obtain a viral load test 4 weeks after ART initiation to assess the response to therapy.
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