Diagnostic Considerations

Human immunodeficiency virus (HIV) infection should be considered in any patient with unusual or recurrent serious infections without another cause, especially in those with risk factors for HIV infection.

Any of the opportunistic infections or cancers associated with acquired immune deficiency syndrome (AIDS) can also occur in the absence of HIV infection, although they usually develop in patients with some other form of immune suppression or defect. The possibility of HIV infection must be considered on a case-by-case basis. Other causes of immune suppression (eg, chemotherapy, immune disorders, severe combined immune deficiency [SCID], severe malnutrition) should be considered. For example, a young adult with leukemia undergoing chemotherapy is at high risk for many opportunistic infections.

Differential Diagnoses

Workup

Justiz Vaillant AA, Naik R. HIV-1 Associated Opportunistic Infections. StatPearls. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Waymack JR, Sundareshan V. Acquired Immune Deficiency Syndrome. StatPearls. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
US Preventive Services Task Force., Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, et al. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Jun 18. 321 (23):2326-2336. [QxMD MEDLINE Link]. [Full Text].
Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [QxMD MEDLINE Link]. [Full Text].
Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Owens DK. Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009 Jan 20. 150(2):125-31. [QxMD MEDLINE Link]. [Full Text].
Centers for Disease Control and Prevention. Laboratory testing for the diagnosis of HIV infection : updated recommendations. Centers for Disease Control and Prevention. Available at https://stacks.cdc.gov/view/cdc/23447. June 27, 2014; Accessed: January 9, 2023.
World Health Organization (WHO). HIV/AIDS. World Health Organization (WHO). Available at https://www.who.int/health-topics/hiv-aids/#tab=tab_1.
Reynolds SJ, Makumbi F, Newell K, et al. Effect of daily aciclovir on HIV disease progression in individuals in Rakai, Uganda, co-infected with HIV-1 and herpes simplex virus type 2: a randomised, double-blind placebo-controlled trial. Lancet Infect Dis. 2012 Jun. 12(6):441-8. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. October 17, 2017. U.S. Department of Health and Human Services. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf. September 21, 2022; Accessed: January 9, 2023.
US Food and Drug Administration. FDA approves first rapid diagnostic test to detect both HIV-1 antigen and HIV-1/2 antibodies. US Department of Health and Human Services, US Food and Drug Administration. Available at https://www.hiv.gov/blog/fda-approves-first-rapid-diagnostic-test-to-detect-both-hiv-1-antigen-and-hiv-12-antibodies. August 8, 2013; Accessed: January 9, 2023.
Lowes R. FDA OKs First Rapid Test for HIV-1/2 Antibodies, HIV-1 Antigen. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/809183. Accessed: August 15, 2013.
1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992 Dec 18. 41:1-19. [QxMD MEDLINE Link]. [Full Text].
[Guideline] HHS Panel on Antiretroviral Guidelines for Adults and Adolescents—A Working Group of the Office of AIDS Research Advisory Council (OARAC). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. DHHS. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf. Last update: Sep. 21, 2022; Accessed: December 29, 2022.
Talal AH, Monard S, Vesanen M, et al. Virologic and immunologic effect of antiretroviral therapy on HIV-1 in gut-associated lymphoid tissue. J Acquir Immune Defic Syndr. 2001 Jan 1. 26(1):1-7. [QxMD MEDLINE Link]. [Full Text].
Guadalupe M, Reay E, Sankaran S, et al. Severe CD4+ T-cell depletion in gut lymphoid tissue during primary human immunodeficiency virus type 1 infection and substantial delay in restoration following highly active antiretroviral therapy. J Virol. 2003 Nov. 77(21):11708-17. [QxMD MEDLINE Link]. [Full Text].
Shacklett BL, Cox CA, Sandberg JK, Stollman NH, Jacobson MA, Nixon DF. Trafficking of human immunodeficiency virus type 1-specific CD8+ T cells to gut-associated lymphoid tissue during chronic infection. J Virol. 2003 May. 77(10):5621-31. [QxMD MEDLINE Link]. [Full Text].
Guadalupe M, Sankaran S, George MD, et al. Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection. J Virol. 2006 Aug. 80(16):8236-47. [QxMD MEDLINE Link]. [Full Text].
Re F, Braaten D, Franke EK, Luban J. Human immunodeficiency virus type 1 Vpr arrests the cell cycle in G2 by inhibiting the activation of p34cdc2-cyclin B. J Virol. 1995 Nov. 69(11):6859-64. [QxMD MEDLINE Link]. [Full Text].
Keating SM, Golub ET, Nowicki M, et al. The effect of HIV infection and HAART on inflammatory biomarkers in a population-based cohort of women. AIDS. 2011 Sep 24. 25(15):1823-32. [QxMD MEDLINE Link]. [Full Text].
Landires I, Bugault F, Lambotte O, et al. HIV infection perturbs interleukin-7 signaling at the step of STAT5 nuclear relocalization. AIDS. 2011 Sep 24. 25(15):1843-53. [QxMD MEDLINE Link]. [Full Text].
Lederman MM. Immune restoration and CD4+ T-cell function with antiretroviral therapies. AIDS. 2001 Feb. 15 Suppl 2:S11-5. [QxMD MEDLINE Link]. [Full Text].
Finkel TH, Tudor-Williams G, Banda NK, et al. Apoptosis occurs predominantly in bystander cells and not in productively infected cells of HIV- and SIV-infected lymph nodes. Nat Med. 1995 Feb. 1(2):129-34. [QxMD MEDLINE Link]. [Full Text].
Liu R, Paxton WA, Choe S, et al. Homozygous defect in HIV-1 coreceptor accounts for resistance of some multiply-exposed individuals to HIV-1 infection. Cell. 1996 Aug 9. 86(3):367-77. [QxMD MEDLINE Link]. [Full Text].
U.S. Department of Health and Human Services. AIDSInfo. AIDSInfo. Available at https://www.hiv.gov/authors/aidsinfo. Accessed: January 9, 2023.
Jeffrey S. FDA approves first antidiarrheal drug for HIV/AIDS. Medscape Medical News. Dec 31, 2012. [Full Text].
Gao F, Bailes E, Robertson DL, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature. 1999 Feb 4. 397(6718):436-41. [QxMD MEDLINE Link]. [Full Text].
Hirsch VM, Olmsted RA, Murphey-Corb M, Purcell RH, Johnson PR. An African primate lentivirus (SIVsm) closely related to HIV-2. Nature. 1989 Jun 1. 339(6223):389-92. [QxMD MEDLINE Link]. [Full Text].
Popper SJ, Sarr AD, Gueye-Ndiaye A, Mboup S, Essex ME, Kanki PJ. Low plasma human immunodeficiency virus type 2 viral load is independent of proviral load: low virus production in vivo. J Virol. 2000 Feb. 74(3):1554-7. [QxMD MEDLINE Link]. [Full Text].
Popper SJ, Sarr AD, Travers KU, et al. Lower human immunodeficiency virus (HIV) type 2 viral load reflects the difference in pathogenicity of HIV-1 and HIV-2. J Infect Dis. 1999 Oct. 180(4):1116-21. [QxMD MEDLINE Link]. [Full Text].
Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997 Jun 15. 126(12):946-54. [QxMD MEDLINE Link]. [Full Text].
Rodríguez B, Sethi AK, Cheruvu VK, et al. Predictive value of plasma HIV RNA level on rate of CD4 T-cell decline in untreated HIV infection. JAMA. 2006 Sep 27. 296(12):1498-506. [QxMD MEDLINE Link]. [Full Text].
Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep. 1981 Jul 3. 30(25):305-8. [QxMD MEDLINE Link]. [Full Text].
Barre-Sinoussi F, Chermann JC, Rey F, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983 May 20. 220(4599):868-71. [QxMD MEDLINE Link]. [Full Text].
Ascher MS, Sheppard HW, Winkelstein W Jr, Vittinghoff E. Does drug use cause AIDS?. Nature. 1993 Mar 11. 362(6416):103-4. [QxMD MEDLINE Link]. [Full Text].
Korber B, Muldoon M, Theiler J, et al. Timing the ancestor of the HIV-1 pandemic strains. Science. 2000 Jun 9. 288(5472):1789-96. [QxMD MEDLINE Link]. [Full Text].
Koopman G, Haaksma AG, ten Velden J, Hack CE, Heeney JL. The relative resistance of HIV type 1-infected chimpanzees to AIDS correlates with the maintenance of follicular architecture and the absence of infiltration by CD8+ cytotoxic T lymphocytes. AIDS Res Hum Retroviruses. 1999 Mar 1. 15(4):365-73. [QxMD MEDLINE Link]. [Full Text].
Birch MR, Learmont JC, Dyer WB, et al. An examination of signs of disease progression in survivors of the Sydney Blood Bank Cohort (SBBC). J Clin Virol. 2001 Oct. 22(3):263-70. [QxMD MEDLINE Link]. [Full Text].
Dyer WB, Geczy AF, Kent SJ, et al. Lymphoproliferative immune function in the Sydney Blood Bank Cohort, infected with natural nef/long terminal repeat mutants, and in other long-term survivors of transfusion-acquired HIV-1 infection. AIDS. 1997 Nov. 11(13):1565-74. [QxMD MEDLINE Link].
Pantaleo G, Graziosi C, Fauci AS. New concepts in the immunopathogenesis of human immunodeficiency virus infection. N Engl J Med. 1993 Feb 4. 328(5):327-35. [QxMD MEDLINE Link].
Pantaleo G, Fauci AS. New concepts in the immunopathogenesis of HIV infection. Annu Rev Immunol. 1995. 13:487-512. [QxMD MEDLINE Link].
Weber J. The pathogenesis of HIV-1 infection. Br Med Bull. 2001. 58:61-72. [QxMD MEDLINE Link].
Frazer IH, Mackay IR, Crapper RM, et al. Immunological abnormalities in asymptomatic homosexual men: correlation with antibody to HTLV-III and sequential changes over two years. Q J Med. 1986 Oct. 61(234):921-33. [QxMD MEDLINE Link].
Schechter MT, Boyko WJ, Craib KJ, et al. Effects of long-term seropositivity to human immunodeficiency virus in a cohort of homosexual men. AIDS. 1987 Jul. 1(2):77-82. [QxMD MEDLINE Link].
Talal AH, Irwin CE, Dieterich DT, Yee H, Zhang L. Effect of HIV-1 infection on lymphocyte proliferation in gut-associated lymphoid tissue. J Acquir Immune Defic Syndr. 2001 Mar 1. 26(3):208-17. [QxMD MEDLINE Link].
Poles MA, Boscardin WJ, Elliott J, et al. Lack of decay of HIV-1 in gut-associated lymphoid tissue reservoirs in maximally suppressed individuals. J Acquir Immune Defic Syndr. 2006 Sep. 43(1):65-8. [QxMD MEDLINE Link].
van Marle G, Gill MJ, Kolodka D, McManus L, Grant T, Church DL. Compartmentalization of the gut viral reservoir in HIV-1 infected patients. Retrovirology. 2007 Dec 4. 4:87. [QxMD MEDLINE Link]. [Full Text].
Al-Harthi L, Marchetti G, Steffens CM, Poulin J, Sékaly R, Landay A. Detection of T cell receptor circles (TRECs) as biomarkers for de novo T cell synthesis using a quantitative polymerase chain reaction-enzyme linked immunosorbent assay (PCR-ELISA). J Immunol Methods. 2000 Apr 3. 237(1-2):187-97. [QxMD MEDLINE Link].
Hellerstein M, Hanley MB, Cesar D, et al. Directly measured kinetics of circulating T lymphocytes in normal and HIV-1-infected humans. Nat Med. 1999 Jan. 5(1):83-9. [QxMD MEDLINE Link].
Bandera A, Ferrario G, Saresella M, et al. CD4+ T cell depletion, immune activation and increased production of regulatory T cells in the thymus of HIV-infected individuals. PLoS One. 2010 May 24. 5(5):e10788. [QxMD MEDLINE Link]. [Full Text].
Franco JM, Rubio A, Martínez-Moya M, et al. T-cell repopulation and thymic volume in HIV-1-infected adult patients after highly active antiretroviral therapy. Blood. 2002 May 15. 99(10):3702-6. [QxMD MEDLINE Link].
Mohri H, Perelson AS, Tung K, et al. Increased turnover of T lymphocytes in HIV-1 infection and its reduction by antiretroviral therapy. J Exp Med. 2001 Nov 5. 194(9):1277-87. [QxMD MEDLINE Link]. [Full Text].
Bird JJ, Brown DR, Mullen AC, et al. Helper T cell differentiation is controlled by the cell cycle. Immunity. 1998 Aug. 9(2):229-37. [QxMD MEDLINE Link].
Samson M, Libert F, Doranz BJ, et al. Resistance to HIV-1 infection in caucasian individuals bearing mutant alleles of the CCR-5 chemokine receptor gene. Nature. 1996 Aug 22. 382(6593):722-5. [QxMD MEDLINE Link].
Poropatich K, Sullivan DJ Jr. Human immunodeficiency virus type 1 long-term non-progressors: the viral, genetic and immunological basis for disease non-progression. J Gen Virol. 2011 Feb. 92:247-68. [QxMD MEDLINE Link].
van der Ende ME, Schutten M, Raschdorff B, et al. CD4 T cells remain the major source of HIV-1 during end stage disease. AIDS. 1999 Jun 18. 13(9):1015-9. [QxMD MEDLINE Link].
Allers K, Hutter G, Hofmann J, et al. Evidence for the cure of HIV infection by CCR5?32/?32 stem cell transplantation. Blood. 2011 Mar 10. 117(10):2791-9. [QxMD MEDLINE Link].
Kostense S, Raaphorst FM, Notermans DW, et al. Diversity of the T-cell receptor BV repertoire in HIV-1-infected patients reflects the biphasic CD4+ T-cell repopulation kinetics during highly active antiretroviral therapy. AIDS. 1998 Dec 24. 12(18):F235-40. [QxMD MEDLINE Link].
McCune JM. The dynamics of CD4+ T-cell depletion in HIV disease. Nature. 2001 Apr 19. 410(6831):974-9. [QxMD MEDLINE Link].
Teixeira L, Valdez H, McCune JM, et al. Poor CD4 T cell restoration after suppression of HIV-1 replication may reflect lower thymic function. AIDS. 2001 Sep 28. 15(14):1749-56. [QxMD MEDLINE Link].
Pantaleo G, Graziosi C, Demarest JF, et al. HIV infection is active and progressive in lymphoid tissue during the clinically latent stage of disease. Nature. 1993 Mar 25. 362(6418):355-8. [QxMD MEDLINE Link].
Vago L, Antonacci MC, Cristina S, et al. Morphogenesis, evolution and prognostic significance of lymphatic tissue lesions in HIV infection. Appl Pathol. 1989. 7(5):298-309. [QxMD MEDLINE Link].
Edén A, Fuchs D, Hagberg L, et al. HIV-1 viral escape in cerebrospinal fluid of subjects on suppressive antiretroviral treatment. J Infect Dis. 2010 Dec 15. 202(12):1819-25. [QxMD MEDLINE Link]. [Full Text].
Karris MY, Anderson CM, Morris SR, Smith DM, Little SJ. Cost savings associated with testing of antibodies, antigens, and nucleic acids for diagnosis of acute HIV infection. J Clin Microbiol. 2012 Jun. 50(6):1874-8. [QxMD MEDLINE Link]. [Full Text].
Pruss D, Bushman FD, Wolffe AP. Human immunodeficiency virus integrase directs integration to sites of severe DNA distortion within the nucleosome core. Proc Natl Acad Sci U S A. 1994 Jun 21. 91(13):5913-7. [QxMD MEDLINE Link].
Schröder AR, Shinn P, Chen H, Berry C, Ecker JR, Bushman F. HIV-1 integration in the human genome favors active genes and local hotspots. Cell. 2002 Aug 23. 110(4):521-9. [QxMD MEDLINE Link].
Blankson JN, Persaud D, Siliciano RF. The challenge of viral reservoirs in HIV-1 infection. Annu Rev Med. 2002. 53:557-93. [QxMD MEDLINE Link].
Chun TW, Engel D, Berrey MM, Shea T, Corey L, Fauci AS. Early establishment of a pool of latently infected, resting CD4(+) T cells during primary HIV-1 infection. Proc Natl Acad Sci U S A. 1998 Jul 21. 95(15):8869-73. [QxMD MEDLINE Link].
Ho DD, Moudgil T, Alam M. Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med. 1989 Dec 14. 321(24):1621-5. [QxMD MEDLINE Link].
Saez-Cirion A, Lacabaratz C, Lambotte O, et al. HIV controllers exhibit potent CD8 T cell capacity to suppress HIV infection ex vivo and peculiar cytotoxic T lymphocyte activation phenotype. Proc Natl Acad Sci U S A. 2007 Apr 17. 104(16):6776-81. [QxMD MEDLINE Link]. [Full Text].
Kaul R, Plummer FA, Kimani J, et al. HIV-1-specific mucosal CD8+ lymphocyte responses in the cervix of HIV-1-resistant prostitutes in Nairobi. J Immunol. 2000 Feb 1. 164(3):1602-11. [QxMD MEDLINE Link].
Alimonti JB, Kimani J, Matu L, et al. Characterization of CD8 T-cell responses in HIV-1-exposed seronegative commercial sex workers from Nairobi, Kenya. Immunol Cell Biol. 2006 Oct. 84(5):482-5. [QxMD MEDLINE Link].
Alter G, Heckerman D, Schneidewind A, et al. HIV-1 adaptation to NK-cell-mediated immune pressure. Nature. 2011 Aug 3. 476(7358):96-100. [QxMD MEDLINE Link]. [Full Text].
Zoufaly A, an der Heiden M, Kollan C, et al. Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy. J Infect Dis. 2011 Feb 1. 203(3):364-71. [QxMD MEDLINE Link]. [Full Text].
Mills EJ, Bakanda C, Birungi J, Yaya S, Ford N. The prognostic value of baseline CD4 cell count beyond 6 months of antiretroviral therapy in HIV positive patients in Uganda. AIDS. 2012 Apr 21. [QxMD MEDLINE Link].
Ezeamama AE, Spiegelman D, Hertzmark E, et al. HIV infection and the incidence of malaria among HIV-exposed children from Tanzania. J Infect Dis. 2012 May 15. 205(10):1486-94. [QxMD MEDLINE Link]. [Full Text].
Lambert-Niclot S, Tubiana R, Beaudoux C, et al. Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma on a 2002-2011 survey. AIDS. 2012 May 15. 26(8):971-5. [QxMD MEDLINE Link].
Scherzer R, Estrella M, Li Y, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS. 2012 Apr 24. 26(7):867-75. [QxMD MEDLINE Link].
CDC. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Preliminary), Volume 30. CDC. Available at https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-preliminary-vol-30.pdf. November 2019; Accessed: January 9, 2023.
Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Preliminary). Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. December 2018; Accessed: March 5, 2020.
Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men --- 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010 Sep 24. 59(37):1201-7. [QxMD MEDLINE Link].
Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Available at http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed: June 21, 2011.
Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. MMWR Morb Mortal Wkly Rep. 2012 Nov 30. 61(47):971-6. [QxMD MEDLINE Link]. [Full Text].
UNAIDS. Global AIDS update 2019 — Communities at the centre. UNAIDS. Available at https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf. December 10, 2019; Accessed: March 5, 2020.
Ng M, Gakidou E, Levin-Rector A, Khera A, Murray CJ, Dandona L. Assessment of population-level effect of Avahan, an HIV-prevention initiative in India. Lancet. 2011 Nov 5. 378(9803):1643-52. [QxMD MEDLINE Link].
Greenhalgh H. Men With Same-Sex Partners 28 Times More Likely to Get HIV - U.N. Medscape News. Available at https://www.medscape.com/viewarticle/899482. July 19, 2018; Accessed: July 24, 2018.
Creswell JD, Myers HF, Cole SW, Irwin MR. Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: a small randomized controlled trial. Brain Behav Immun. 2009 Feb. 23(2):184-8. [QxMD MEDLINE Link]. [Full Text].
Cao Y, Qin L, Zhang L, Safrit J, Ho DD. Virologic and immunologic characterization of long-term survivors of human immunodeficiency virus type 1 infection. N Engl J Med. 1995 Jan 26. 332(4):201-8. [QxMD MEDLINE Link].
Levy JA. HIV pathogenesis and long-term survival. AIDS. 1993 Nov. 7(11):1401-10. [QxMD MEDLINE Link].
Pantaleo G, Menzo S, Vaccarezza M, et al. Studies in subjects with long-term nonprogressive human immunodeficiency virus infection. N Engl J Med. 1995 Jan 26. 332(4):209-16. [QxMD MEDLINE Link].
Paroli M, Propato A, Accapezzato D, Francavilla V, Schiaffella E, Barnaba V. The immunology of HIV-infected long-term non-progressors--a current view. Immunol Lett. 2001 Nov 1. 79(1-2):127-9. [QxMD MEDLINE Link].
Nesheim SR, Kapogiannis BG, Soe MM, et al. Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, 1986-2004. Pediatrics. 2007 Jul. 120(1):100-9. [QxMD MEDLINE Link].
Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006 Sep 19. 145(6):397-406. [QxMD MEDLINE Link]. [Full Text].
Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006 Sep. 43(1):27-34. [QxMD MEDLINE Link].
Brooks M. Low Level HIV Viremia a Modifiable Risk Factor for Non-Hodgkin Lymphoma. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821277. Accessed: March 12, 2014.
Achenbach CJ, Buchanan AL, Cole SR, Hou L, Mugavero MJ, Crane HM, et al. HIV viremia and incidence of non-Hodgkin lymphoma in patients successfully treated with antiretroviral therapy. Clin Infect Dis. 2014 Feb 12. [QxMD MEDLINE Link].
[Guideline] Brooks M. New CDC HIV Testing Recommendations Offer Faster Diagnosis. Medscape Medical News. Jun 26 2014. [Full Text].
[Guideline] CDC. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf. Accessed: Jul 7 2014.
Barclay L. ACOG Guidelines Recommend Repeat HIV Screening, Prophylaxis. Medscape Medical News. Available at http://www.medscape.com/viewarticle/824112. Accessed: May 3, 2014.
[Guideline] Committee Opinion No 596: Routine Human Immunodeficiency Virus Screening. Obstet Gynecol. 2014 May. 123(5):1137-1139. [QxMD MEDLINE Link].
Skwarecki B. ACOG updates recommendations for prenatal HIV testing. Available at:. Medscape Medical News. WebMD Inc. Available at http://www.medscape.com/viewarticle/845416. May 27, 2015;
[Guideline] American College of Obstetricians and Gynecologists. Committee opinion no: 635: prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015 Jun. 125 (6):1544-7. [QxMD MEDLINE Link].
Torian LV, Eavey JJ, Punsalang AP, et al. HIV type 2 in New York City, 2000-2008. Clin Infect Dis. 2010 Dec 1. 51(11):1334-42. [QxMD MEDLINE Link].
Claassen CW, Diener-West M, Mehta SH, Thomas DL, Kirk GD. Discordance Between CD4+ T-Lymphocyte Counts and Percentages in HIV-Infected Persons With Liver Fibrosis. Clin Infect Dis. 2012 Jun. 54(12):1806-13. [QxMD MEDLINE Link].
Detection of Acute HIV Infection in Two Evaluations of a New HIV Diagnostic Testing Algorithm - United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2013 Jun 21. 62(24):489-94. [QxMD MEDLINE Link].
Hull MW, Rollet K, Odueyungbo A, et al. Factors associated with discordance between absolute CD4 cell count and CD4 cell percentage in patients coinfected with HIV and hepatitis C virus. Clin Infect Dis. 2012 Jun. 54(12):1798-805. [QxMD MEDLINE Link].
Hoffmann CJ, Brown TT. Thyroid function abnormalities in HIV-infected patients. Clin Infect Dis. 2007 Aug 15. 45(4):488-94. [QxMD MEDLINE Link].
Lee PL, Yiannoutsos CT, Ernst T, et al. A multi-center 1H MRS study of the AIDS dementia complex: validation and preliminary analysis. J Magn Reson Imaging. 2003 Jun. 17(6):625-33. [QxMD MEDLINE Link].
Bucy RP, Hockett RD, Derdeyn CA, et al. Initial increase in blood CD4(+) lymphocytes after HIV antiretroviral therapy reflects redistribution from lymphoid tissues. J Clin Invest. 1999 May 15. 103(10):1391-8. [QxMD MEDLINE Link]. [Full Text].
Pakker NG, Notermans DW, de Boer RJ, et al. Biphasic kinetics of peripheral blood T cells after triple combination therapy in HIV-1 infection: a composite of redistribution and proliferation. Nat Med. 1998 Feb. 4(2):208-14. [QxMD MEDLINE Link].
Masia M, Padilla S, Alvarez D, et al. Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy. AIDS. 2013 Jan 14. 27(2):181-9. [QxMD MEDLINE Link].
Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, et al. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6. 73 (11):e3572-e3605. [QxMD MEDLINE Link].
Simard EP, Engels EA. Cancer as a cause of death among people with AIDS in the United States. Clin Infect Dis. 2010 Oct 15. 51(8):957-62. [QxMD MEDLINE Link]. [Full Text].
Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst. 2011 May 4. 103(9):753-62. [QxMD MEDLINE Link]. [Full Text].
Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C. Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. Clin Infect Dis. 2010 Oct 15. 51(8):947-56. [QxMD MEDLINE Link]. [Full Text].
Sterne JA, May M, Costagliola D, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009 Apr 18. 373(9672):1352-63. [QxMD MEDLINE Link]. [Full Text].
Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. 2010 Jul 15. 363(3):257-65. [QxMD MEDLINE Link].
Cain LE, Logan R, Robins JM, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study. Ann Intern Med. 2011 Apr 19. 154(8):509-15. [QxMD MEDLINE Link].
US Department of Health and Human Services. National Institutes of Health. NIH News. Starting Antiretroviral Therapy Earlier Yields Better Clinical Outcomes. June 8, 2009.
Hecht FM, Wang L, Collier A, et al. A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection. J Infect Dis. 2006 Sep 15. 194(6):725-33. [QxMD MEDLINE Link].
Hecht FM, Wellman R, Busch MP, et al. Identifying the early post-HIV antibody seroconversion period. J Infect Dis. 2011 Aug 15. 204(4):526-33. [QxMD MEDLINE Link]. [Full Text].
Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2020 Oct 27. 324 (16):1651-1669. [QxMD MEDLINE Link].
Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2023 Jan 3. 329 (1):63-84. [QxMD MEDLINE Link].
Rhee SY, Taylor J, Fessel WJ, et al. HIV-1 protease mutations and protease inhibitor cross-resistance. Antimicrob Agents Chemother. 2010 Oct. 54(10):4253-61. [QxMD MEDLINE Link]. [Full Text].
Lennox JL, DeJesus E, Lazzarin A, et al. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatment-naive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet. 2009 Sep 5. 374(9692):796-806. [QxMD MEDLINE Link].
Rockstroh JK, DeJesus E, Lennox JL, et al. Durable efficacy and safety of raltegravir versus efavirenz when combined with tenofovir/emtricitabine in treatment-naive HIV-1-infected patients: final 5-year results from STARTMRK. J Acquir Immune Defic Syndr. 2013 May 1. 63(1):77-85. [QxMD MEDLINE Link].
Raffi F, Rachlis A, Stellbrink HJ, Hardy WD, Torti C, Orkin C, et al. Once-daily dolutegravir versus raltegravir in antiretroviral-naive adults with HIV-1 infection: 48 week results from the randomised, double-blind, non-inferiority SPRING-2 study. Lancet. 2013 Mar 2. 381(9868):735-43. [QxMD MEDLINE Link].
Walmsley S, Antela A, Clumeck N, et al. Dolutegravir (DTG; S/GSK1349572) + Abacavir/Lamivudine Once Daily Statistically Superior to Tenofovir/Emtricitabine/Efavirenz: 48-Week Results - SINGLE (ING114467). Abstract presented at: 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Sept 2012. Abstract H-556b:
Cahn P, Pozniak AL, Mingrone H, Shuldyakov A, Brites C, Andrade-Villanueva JF, et al. Dolutegravir versus raltegravir in antiretroviral-experienced, integrase-inhibitor-naive adults with HIV: week 48 results from the randomised, double-blind, non-inferiority SAILING study. Lancet. 2013 Jul 2. [QxMD MEDLINE Link].
Nichols G, Mills A, Grossberg R, et al. Antiviral Activity of Dolutegravir in Subjects With Failure on an Integrase Inhibitor–Based Regimen: Week 24 Phase 3 Results From VIKING-3. Poster presented at: 11th International Congress on Drug Therapy in HIV Infection. Nov 2012. Poster O232:
Ndembi N, Goodall RL, Dunn DT, et al. Viral rebound and emergence of drug resistance in the absence of viral load testing: a randomized comparison between zidovudine-lamivudine plus Nevirapine and zidovudine-lamivudine plus Abacavir. J Infect Dis. 2010 Jan 1. 201(1):106-13. [QxMD MEDLINE Link].
Sax PE, DeJesus E, Mills A, et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks. Lancet. 2012 Jun 30. 379(9835):2439-48. [QxMD MEDLINE Link].
DeJesus E, Rockstroh JK, Henry K, et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate versus ritonavir-boosted atazanavir plus co-formulated emtricitabine and tenofovir disoproxil fumarate for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet. 2012 Jun 30. 379(9835):2429-38. [QxMD MEDLINE Link].
McMahon DK, Zheng L, Hitti J, Chan ES, Halvas EK, Hong F, et al. Greater Suppression of Nevirapine Resistance With 21- vs 7-Day Antiretroviral Regimens After Intrapartum Single-Dose Nevirapine for Prevention of Mother-to-Child Transmission of HIV. Clin Infect Dis. 2013 Apr. 56(7):1044-51. [QxMD MEDLINE Link]. [Full Text].
Spector SA, McKinley GF, Lalezari JP, et al. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1996 Jun 6. 334(23):1491-7. [QxMD MEDLINE Link].
Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries. Clin Infect Dis. 2012 May. 54(9):1364-72. [QxMD MEDLINE Link].
Falutz J, Potvin D, Mamputu JC, et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010 Mar 1. 53(3):311-22. [QxMD MEDLINE Link].
Falutz J, Allas S, Blot K, Potvin D, Kotler D, Somero M, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007 Dec 6. 357(23):2359-70. [QxMD MEDLINE Link].
Falutz J, Mamputu JC, Potvin D, Moyle G, Soulban G, Loughrey H, et al. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab. 2010 Sep. 95(9):4291-304. [QxMD MEDLINE Link].
Stanley TL, Falutz J, Marsolais C, et al. Reduction in visceral adiposity is associated with an improved metabolic profile in HIV-infected patients receiving tesamorelin. Clin Infect Dis. 2012 Jun. 54(11):1642-51. [QxMD MEDLINE Link]. [Full Text].
Lingappa JR, Baeten JM, Wald A, Hughes JP, Thomas KK, Mujugira A, et al. Daily acyclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial. Lancet. 2010 Mar 6. 375(9717):824-33. [QxMD MEDLINE Link]. [Full Text].
Ruel TD, Boivin MJ, Boal HE, et al. Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts. Clin Infect Dis. 2012 Apr. 54(7):1001-9. [QxMD MEDLINE Link]. [Full Text].
Gaps in HIV Testing and Treatment Hinder Efforts to Stop New Infections. CDC. Available at https://www.cdc.gov/media/releases/2019/p0315-gaps-hinder-hiv-testing.html. March 18, 2019; Accessed: March 20, 2019.
Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2011 Oct 3. [QxMD MEDLINE Link].
Marazzi MC, Palombi L, Nielsen-Saines K, et al. Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes. AIDS. 2011 Aug 24. 25(13):1611-8. [QxMD MEDLINE Link].
Burgard M, Jasseron C, Matheron S, et al. Mother-to-child transmission of HIV-2 infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1. Clin Infect Dis. 2010 Oct 1. 51(7):833-43. [QxMD MEDLINE Link].
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009 Dec 3. 361(23):2209-20. [QxMD MEDLINE Link].
Robb ML, Rerks-Ngarm S, Nitayaphan S, et al. Risk behaviour and time as covariates for efficacy of the HIV vaccine regimen ALVAC-HIV (vCP1521) and AIDSVAX B/E: a post-hoc analysis of the Thai phase 3 efficacy trial RV 144. Lancet Infect Dis. 2012 Jul. 12(7):531-7. [QxMD MEDLINE Link]. [Full Text].
Brooks M. CDC updates HIV preexposure prophylaxis guidelines. Medscape Medical News. May 14, 2014. [Full Text].
Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 Clinical Practice Guideline. Centers for Disease Control and Prevention. May 2014. Available at http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.
Descovy (emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences. October, 2019. Available at [Full Text].
Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30. 363(27):2587-99. [QxMD MEDLINE Link]. [Full Text].
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11. 365(6):493-505. [QxMD MEDLINE Link]. [Full Text].
Choopanya K, Martin M, Suntharasam P, Sangkum U, Mock P, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomized, double-blind, placebo-controlled phase 3 trial. Lancet. 2013. 2083-90.
Leibowitz AA, Parker KB, Rotheram-Borus MJ. A US Policy Perspective on Oral Preexposure Prophylaxis for HIV. Am J Public Health. 2011 Jun. 101(6):982-5. [QxMD MEDLINE Link].
Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011 Jan 28. 60(3):65-8. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention. Last updated February 22, 2011. HIV/AIDS - Pre-Exposure Prophylaxis (PrEP). [Full Text].
[Guideline] Marrazzo JM, del Rio C, Holtgrave DR, et al, for the International Antiviral Society-USA Panel. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312(4):390-409. [QxMD MEDLINE Link]. [Full Text].
Smith M. Antiviral group: 'Biomedical' tx could slow HIV. MedPage Today. July 21, 2014. [Full Text].
[Guideline] Günthard HF, Aberg JA, Eron JJ, for the International Antiviral Society-USA Panel. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312(4):410-25. [QxMD MEDLINE Link]. [Full Text].
[Guideline] DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, et al. Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017 Aug 11. 66 (31):830-832. [QxMD MEDLINE Link].
EACS. European AIDS Clinical Society Guidelines Version 10.0. European AIDS Clinical Society. Available at https://www.eacsociety.org/files/2019_guidelines-10.0_final.pdf. November 2019; Accessed: December 2, 2019.
[Guideline] Department of Health and Human Services. Panel on Clinical Practices for Treatment of HIV Infection., Henry J. Kaiser Family Foundation. Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents, January 28, 2000 by the Panel on Clinical Practices for Treatment of HIV Infection. HIV Clin Trials. 2000 Jul-Aug. 1 (1):60-110. [QxMD MEDLINE Link]. [Full Text].
Mounzer K, Palella F, Slim J, et al. SPIRIT: Simplifying to rilpivirine/emtricitabine/tenofovir Df single-tablet regimen from boosted protease inhibitor regimen maintains HIV suppression in the black subgroup [abstract H-656]. Presented at: The 53rd Interscience Conference onAntimicrobial Agents and Chemotherapy (ICAAC); September 11, 2013; Denver, Colorado. [Full Text].
Kling J. Single-tablet HIV regimen effective. Medscape Medical News. September 19, 2013. [Full Text].
Tucker ME. FDA OKs New Triple-Combination Pill (Triumeq) for HIV. Medscape Medical News. Aug 22 2014. [Full Text].
Molina JM, Squires K, Sax PE, Cahn P, Lombaard J, DeJesus E, et al. Doravirine versus ritonavir-boosted darunavir in antiretroviral-naive adults with HIV-1 (DRIVE-FORWARD): 48-week results of a randomised, double-blind, phase 3, non-inferiority trial. Lancet HIV. 2018 May. 5 (5):e211-e220. [QxMD MEDLINE Link].
Orkin C, Squires KE, Molina JM, Sax PE, Wong WW, Sussmann O, et al. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate is Non-inferior to Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate in Treatment-naive Adults With Human Immunodeficiency Virus-1 Infection: Week 48 Results of the DRIVE-AHEAD Trial. Clin Infect Dis. 2018 Aug 31. [QxMD MEDLINE Link].
Lewis S, Fessel J, Emu B, Schrader S, Kumar P, Richmond GJ, et al. Long-acting ibalizumab in patients with multi-drug resistant HIV-1: A 24-week study. Presented at the 2017 Conference on Retroviruses and Opportunistic Infections. February 13-16, 2017. Seattle, WA. Abstracts from the 2017 Conference on Retroviruses and Opportunistic Infections. February 13-16, 2017. Seattle, Washington. Top Antivir Med. 2017 Apr. 25 (1s):4s-446s. [QxMD MEDLINE Link]. [Full Text].
Segal-Maurer S, DeJesus E, Stellbrink HJ, and the, CAPELLA Study Investigators. Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection. N Engl J Med. 2022 May 12. 386 (19):1793-1803. [QxMD MEDLINE Link]. [Full Text].
Barclay L. HIV: guidelines stress role of primary care in management. Medscape Medical News. November 14, 2013. [Full Text].
Mocellin LP, Ziegelmann PK, Kuchenbecker R. A systematic review and meta-analysis assessing antiretroviral therapy for treatment-experienced HIV adult patients using an optimized background therapy approach: is there evidence enough for a standardized third-line strategy?. Syst Rev. 2022 Nov 17. 11 (1):243. [QxMD MEDLINE Link].

Media Gallery

Electron microscopy of human immunodeficiency virus (HIV)–1 virions. Courtesy of CDC (Dr Edwin P Ewing, Jr).
Genome layout of human immunodeficiency virus (HIV)–1 and HIV-2.
Timeline of CD4 T-cell and viral-load changes over time in untreated human immunodeficiency virus (HIV) infection. Courtesy of Wikipedia (based on an original from Pantaleo et al (1993)).
Incidence of HIV infection by risk group. Courtesy of CDC (derived from the revised 2006 estimated figures).
Changes in survival of people infected with HIV. As therapies have become more aggressive, they have been more effective, although survival with HIV infection is not yet equivalent to that in uninfected people. Modified from Lohse N et al. Survival of persons with and without HIV infection in Denmark, 1995-2005. Ann Intern Med. 2007;146(2):87-95.

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Table 1. Antiretroviral Drug Classes and Agents

Nucleoside reverse transcriptase inhibitors (NRTIs)	Abacavir (Ziagen, ABC) Didanosine (Videx, Videx EC, ddI) Emtricitabine (Emtriva, FTC) Lamivudine (Epivir, 3TC) Stavudine (Zerit, Zerit XR, d4T) Tenofovir DF (Viread, TDF) Tenofovir AF (TAF) Zalcitabine (Hivid, ddC)* Zidovudine (Retrovir, ZDV, AZT)
Protease inhibitors (PIs)	Amprenavir (Agenerase, AVP)* Atazanavir (Reyataz , ATV) Darunavir (Prezista, DRV) Fosamprenavir (Lexiva, f-APV) Indinavir (Crixivan, IDV) Lopinavir and ritonavir (Kaletra, LPV/r) Nelfinavir (Viracept, NFV) Ritonavir (Norvir, RTV) Saquinavir (Invirase [hard gel] capsule, SQV) Tipranavir (Aptivus, TPV)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)	Delavirdine (Rescriptor, DLV) Efavirenz (Sustiva, EFV) Etravirine (Intelence, ETR) Nevirapine (Viramune, NVP) Rilpivirine (Edurant) Doravirine (Pifeltro, DOR) Cabotegravir (CAB)
Fusion inhibitors	Enfuvirtide (Fuzeon, T-20)
Cellular chemokine receptor (CCR5) antagonists	Maraviroc (Selzentry, MVC)
Integrase inhibitors	Raltegravir (Isentress, RAL) Dolutegravir (Tivicay, DTG) Elvitegravir (Vitekta, EVG)
Entry inhibitors (CD4 post-attachment inhibitors)	Ibalizumab (Trogarzo, IBA)
gp120 Attachment inhibitors	Fostemsavir (Rukobia, FTR)
Capsid inhibitors	Lenacapavir (Sunlenca, LEN)
*No longer available on market

Table 2. Antiretroviral Combination Products

Drug Content per Tablet/Capsule*	Brand Name	Adult Dose (≥40 kg)
Darunavir 800 mg Cobicistat 150 mg Emtricitabine 200 mg Tenofovir AF 10 mg	Symtuza^#	1 tab PO qd with food
Bictegravir 50 mg Emtricitabine 200 mg Tenofovir AF 25 mg	Biktarvy^#	1 tab PO qd
Efavirenz 400 mg Lamivudine 300 mg Tenofovir DF 300 mg	Symfi Lo^#	1 tab PO qHS on an empty stomach
Efavirenz 600 mg Lamivudine 300 mg Tenofovir DF 300 mg	Symfi^#	1 tab PO qHS on an empty stomach
Dolutegravir 50 mg Rilpivirine 25 mg	Juluca^#	1 tab PO qd with a meal Note: This is a complete once-daily regimen in adults who are virologically suppressed (HIV-1 RNA < 50 copies/mL) on a stable ART regimen for ≥6 months with no history of treatment failure and no known substitutions associated with resistance
Dolutegravir 50 mg Lamivudine 300 mg	Dovato^#	1 tab PO qd with or without food Note: This a complete once-daily regimen in treatment-naïve adults with no known substitutions associated with resistance to dolutegravir or lamivudine
Elvitegravir 150 mg Cobicistat 150 mg Emtricitabine 200 mg Tenofovir AF 10 mg	Genvoya^#	1 tab PO qd
Elvitegravir 150 mg Cobicistat 150 mg Emtricitabine 200 mg Tenofovir DF 300 mg	Stribild^#	1 tab PO qd
Cabotegravir IM copackaged with Rilpivirine IM	Cabenuva^#	One-time initiating injection (on last day of oral lead-in dosing): Cabotegravir 600 mg IM plus rilpivirine 900 mg IM, THEN Once-monthly continuation injections: Cabotegravir 400 mg IM plus rilpivirine 600 mg IM
Abacavir 600 mg Lamivudine 300 mg	Epzicom	1 tab PO qd
Abacavir 600 mg Dolutegravir 50 mg Lamivudine 300 mg	Triumeq	1 tab PO qd
Abacavir 300 mg Lamivudine 150 mg Zidovudine 300 mg	Trizivir	1 tab PO bid
Efavirenz 600 mg Emtricitabine 200 mg Tenofovir DF 300 mg	Atripla^#	1 tab PO qd on empty stomach Note: May be used alone as a complete regimen or in combination with other ARTs
Emtricitabine 200 mg Rilpivirine 25 mg Tenofovir DF 300 mg	Complera^#	1 tab PO qd with a meal
Emtricitabine 200 mg Rilpivirine 25 mg Tenofovir AF 25 mg	Odefsey^#	1 tab PO qd with a meal
Emtricitabine 200 mg Tenofovir DF 300 mg	Truvada	1 tab PO qd CrCl 30-49 mL/min: 1 tab PO q48h CrCl < 30 mL/min: Do not administer
Emtricitabine 200 mg Tenofovir AF 300 mg	Descovy	1 tab PO qd CrCl < 30 mL/min: Do not administer
Lamivudine 150 mg Zidovudine 300 mg	Combivir	1 tab PO bid
Lamivudine 300 mg Tenofovir DF 300 mg	Cimduo	1 tab PO qd
Doravirine 100 mg Lamivudine 300 mg Tenofovir DF 300 mg	Delstrigo^#	1 tab PO qd with or without food
*Not indicated for patients requiring dosage adjustments (eg, weight < 40 kg, renal impairment, hepatic impairment, dose-limiting adverse effects) unless otherwise stated. ^#Complete once-daily regimen

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Author

Shelley A Gilroy, MD, FACP, FIDSA Associate Professor of Medicine, Infectious Disease and HIV Medicine, Albany Medical College; Associate Chief of Staff for Education/DEO, Lead Physician for HIV Medicine, Division of Infectious Diseases, Albany Stratton VA Medical Center

Shelley A Gilroy, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

John J Faragon, PharmD, BCPS, AAHIVP Pharmacist, HIV/HCV Medicine, Division of HIV Medicine and Department of Pharmacy, Albany Medical Center; Regional Pharmacy Director, Northeast Caribbean AIDS Education and Training Center; HIV and HCV Education Consultant, VirologyEd Consultants

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Gilead; Janssen; Merck.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Acknowledgements

Aaron Glatt, MD Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society forHealthcare Epidemiology of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.