HIV/AIDS: An Update ________________________________________________________________________
Recommendations for chemoprophylaxis to prevent opportu- nistic infections are summarized in Table 1 [50]. Prophylactic therapy for these conditions is strongly recommended because these infections are relatively common in patients with HIV, preventive therapy is simple and cost-effective, and efficacy has been established in clinical studies. In addition to chemoprophylaxis, it is recommended that patients with HIV receive immunizations similarly to the general population, with some exceptions. The following live virus vaccines are contraindicated in individuals with a CD4 count of <200 cells/mcL [50]: • Measles • Mumps • Rubella • Varicella • Live attenuated typhoid Ty21a • Yellow fever • Live attenuated influenza vaccine (LAIV), not recommended regardless of CD4 counts Vaccines that have specific recommendations for individuals with HIV, include [50]: • COVID-19 • Hepatitis A (HAV) • Hepatitis B (HBV) • Meningococcus serogroup A, C, W, Y (MenACWY)
According to the Panel on Antiretroviral Guidelines for Adults and Adolescents, antiretroviral therapy is recommended for all individuals with HIV, including those with early HIV infection and should be initiated as soon as possible after diagnosis.
(https://clinicalinfo.hiv.gov/sites/default/files/ guidelines/documents/adult-adolescent-arv/ guidelines-adult-adolescent-arv.pdf. Last accessed March 21, 2025.) Strength of Recommendation : AII (Strong recommendation based on well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes) As noted, for treatment-naïve patients, initial recommended ART generally consists of an oral second-generation INSTI plus two NRTIs. If INSTI resistance is possible and/or if genotype results are not yet available, a boosted PI in combination with two NRTIs is recommended [42]. These regimens result in maximum reduction of viral load for the longest period of time. When used as initial therapy, these regimens will achieve the goal of no detectable virus in the majority of patients after four to six months [42]. PREVENTION OF OPPORTUNISTIC INFECTIONS In absence of timely diagnosis and treatment of HIV, oppor- tunistic infections are often the first clinical indication of AIDS. Pneumocystis pneumonia, Kaposi sarcoma, toxoplasma encephalitis, cytomegalovirus, cryptococcal meningitis, and dis- seminated atypical mycobacterial infection are often hallmarks of AIDS. Before effective ART, these complications occurred on average 7 to 10 years after HIV infection, and patients usu- ally survived only 1 to 2 years after the initial manifestation of AIDS [50]. Depending on the CD4 count and other risk factors, asymp- tomatic patients with HIV may benefit from prescribed prophylaxis against opportunistic infections. Achieving and maintaining durable viral suppression with ART is important in prevention of infection; however, the CDC estimates that in 2022, only 65% of patients linked to care had durable viral suppression. Poor adherence, unfavorable pharmacokinetics, and/or unexplained biologic factors are among causes for suboptimal response to treatment [17; 50]. The NIH, HIV Medicine Association, and Infectious Diseases Society of America (NIH/HIVMA/IDSA) released updated guidelines for opportunistic infections in patients with HIV in 2024.
• Pneumococcal vaccines • Human papillomavirus
Full recommendations for vaccines and the prevention of opportunistic infections among HIV-infected adults and ado- lescents specific opportunistic infection and can be viewed at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical- guidelines-adult-and-adolescent-opportunistic-infections [50]. Tuberculosis and HIV Tuberculosis is the leading cause of morbidity and mortality among people living with HIV worldwide, with an estimated 10.8 million reported cases and 1.25 million deaths in 2023, of which 161,000 deaths were related to HIV-associated TB. Individuals with HIV are at an approximate 16 times greater risk of developing tuberculosis compared with people not infected with HIV. While ART significantly decreases the risk of conversion from latent to active disease, only 56% of patients with TB living with HIV were on ART in 2023. Although the majority of cases of TB are among low- and middle-income countries, the United States accounted for nearly 9,500 cases in 2023, 410 of which were among individuals coinfected with HIV. There were 545 TB-related deaths in 2022 in the United States [52].
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MDCT2026
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