The major updates of the guidelines are summarized below:
- A new section was introduced, which presents the information on the feasibility of initiating ART since the first day of HIV diagnosis.
- The classification of recommended ART regimens for the initiation has been changed. While previously they were classified into recommended, alternative, etc., now the regimens are now divided into: recommended initial regimens of ART for most people regimens recommended for clinical situations (Table 6).
- As the initial therapy for most patients, it is recommended to use regimens based on InI class drugs (dolutegravir, elvitegravir or raltegravir) in combination with emtricitabine and tenofovir (or tenofovir alafenamide, TAF).
- The ban on IP and InI monotherapy is formulated and scientifically substantiated.
- The possibility of using two-component treatment regimens is considered, as well as data on clinical trials of such regimens.
- The latest information on the treatment of patients with HIV-HBV/HCV co-infection is presented.
The U.S. Department of Health and Human Services in the updated guide pays special attention to adherence. In particular, the very concept was reformulated: the context of adherence is now considered in the continuum of services, and is not limited to adherence to ART, as it used to be earlier.
Moreover, the document contains a number of other corrections, updates, additions and extensions in various sections and subdivisions.