<http://schema.org/articleBody>
"&amp;lt;p&amp;gt;In May 2014, the U.S. Department of Health and Human Services (DHHS) revised its HIV treatment guidelines, recommending the implementation of &amp;lt;a href=&amp;quot;https://www.verywell.com/cart-hiv-combination-antiretroviral-therapy-48921&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;1&amp;quot;&amp;gt;antiretroviral therapy (ART)&amp;lt;/a&amp;gt; in all adults diagnosed with HIV, irrespective of &amp;lt;a href=&amp;quot;https://www.verywell.com/what-are-my-hiv-testing-options-49621&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;2&amp;quot;&amp;gt;CD4 counts&amp;lt;/a&amp;gt; or the &amp;lt;a href=&amp;quot;https://www.verywell.com/symptoms-of-hiv-by-stage-48785&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;3&amp;quot;&amp;gt;stage of disease&amp;lt;/a&amp;gt;.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;The recommendations previously called for ART at CD4 counts below 500 cells/mL, with a moderate recommendation for ART at counts over 500 cells/mL.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;Rationale for HIV Treatment on Diagnosis&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;The DHHS decision is supported by evidence that early treatment is associated with a number of positive outcomes, namely:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;a reduction in the risk of death and illnesses associated with HIV disease progression.&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;a reduction in the risk of &amp;lt;a href=&amp;quot;https://www.verywell.com/prevent-mother-to-child-hiv-transmission-49668&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;4&amp;quot;&amp;gt;transmission from mother to child.&amp;lt;/a&amp;gt;&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;a reduction in the risk of transmission from a person infected with HIV.&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;The latter recommendation is supported by evidence that the use of ART can significantly reduce the infectivity of a person with HIV, a strategy popularly known as &amp;lt;a href=&amp;quot;https://www.verywell.com/the-facts-about-hiv-treatment-as-prevention-49133&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;5&amp;quot;&amp;gt;Treatment as Prevention (TasP)&amp;lt;/a&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;It has been further shown that persons provided immediate ART are &amp;lt;a href=&amp;quot;https://www.verywell.com/why-treating-hiv-on-diagnosis-is-officially-a-must-49315&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;6&amp;quot;&amp;gt;53% less likely to develop serious illness&amp;lt;/a&amp;gt;, both HIV-related and non-related, than someone in whom ART is delayed.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;Moreover, early ART confers not only to better outcomes but longer life. According to researchers with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), a 20-year-old person with HIV can now expect to live into his or her early 70s if treated at the time of diagnosis.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;By contrast, deferring ART until a person&amp;amp;#39;s CD4 count drops below 200 cells/mL can reduce that person&amp;amp;#39;s life expectancy by an average of 15 years.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;Recommendations for First-Line Therapy in Untreated Adults&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;For previously untreated (&amp;amp;#34;treatment naive&amp;amp;#34;) patients, the U.S. panel currently recommends one of six drug regimens as their preferred options for first-line therapy:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/triumeq-abacavir-lamivudine-dolutegravir-hiv-drug-49253&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;7&amp;quot;&amp;gt;Triumeq&amp;lt;/a&amp;gt; (dolutegravir &amp;amp;#43; abacavir &amp;amp;#43; lamivudine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/tivicay-dolutegravir-hiv-drug-information-49252&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;8&amp;quot;&amp;gt;Tivicay&amp;lt;/a&amp;gt; (dolutegravir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;9&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/stribild-hiv-treatment-49022&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;10&amp;quot;&amp;gt;Stribild&amp;lt;/a&amp;gt; (elvitegravir &amp;amp;#43; cobicistat &amp;amp;#43; tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/genvoya-drug-treatment-hiv-49023&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;11&amp;quot;&amp;gt;Genvoya&amp;lt;/a&amp;gt; (elvitegravir &amp;amp;#43; cobicistat &amp;amp;#43; tenofovir AF &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/integrase-inhibitors-48802&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;12&amp;quot;&amp;gt;Isentress&amp;lt;/a&amp;gt; (ratelgravir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;13&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;14&amp;quot;&amp;gt;Prezista&amp;lt;/a&amp;gt; (darunavir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;15&amp;quot;&amp;gt;Norvir&amp;lt;/a&amp;gt; (ritonavir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;16&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;The primary rationale for the DHHS preferred status includes a regimen&amp;amp;#39;s low pill burden, easy dosing schedule, reduced side effect profile, and high barrier to drug resistance.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;Since certain conditions may exclude some from taking the preferred options (such as Truvada in patients with kidney impairment), the DHHS lists six alternative regimens for first-line therapy as follow:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/atripla-tenofovir-emtricitabine-efavirenz-49248&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;17&amp;quot;&amp;gt;Atripla&amp;lt;/a&amp;gt; (efavirenz &amp;amp;#43; tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/edurant-rilpivirine-48938&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;18&amp;quot;&amp;gt;Complera&amp;lt;/a&amp;gt; (rilpivirine &amp;amp;#43; tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/evotaz-atazanavir-cobicistat-hiv-drug-information-49250&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;19&amp;quot;&amp;gt;Evotaz&amp;lt;/a&amp;gt; (atazanavir &amp;amp;#43; cobicistat) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;20&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;21&amp;quot;&amp;gt;Reyataz&amp;lt;/a&amp;gt; (atazanavir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;22&amp;quot;&amp;gt;Norvir&amp;lt;/a&amp;gt; (ritonavir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;23&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), taken once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/prezcobix-darunavir-cobicistat-hiv-drug-information-48941&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;24&amp;quot;&amp;gt;Prezcobix&amp;lt;/a&amp;gt; (darunavir &amp;amp;#43; cobicistat) OR\u00A0&amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;25&amp;quot;&amp;gt;Prezista&amp;lt;/a&amp;gt; (darunavir) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/list-of-approved-hiv-antiretroviral-drugs-49309&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;26&amp;quot;&amp;gt;Norvir&amp;lt;/a&amp;gt; (ritonavir) taken in conjunction with &amp;lt;a href=&amp;quot;https://www.verywell.com/epzicom-kivexa-abacavir-lamivudine-hiv-drug-information-48899&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;27&amp;quot;&amp;gt;Epzicom&amp;lt;/a&amp;gt; (abacavir &amp;amp;#43; lamivudine), once daily&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/prezcobix-darunavir-cobicistat-hiv-drug-information-48941&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;28&amp;quot;&amp;gt;Prezcobix&amp;lt;/a&amp;gt; (darunavir &amp;amp;#43; cobicistat) &amp;amp;#43; &amp;lt;a href=&amp;quot;https://www.verywell.com/truvada-tenofovir-emtricitabine-hiv-drug-information-49012&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;29&amp;quot;&amp;gt;Truvada&amp;lt;/a&amp;gt; (tenofovir &amp;amp;#43; emtricitabine), once daily&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Sources:&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Department of Health and Human Services (DHHS). &amp;lt;a href=&amp;quot;https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;externalLink&amp;quot; data-ordinal=&amp;quot;30&amp;quot;&amp;gt;&amp;amp;#34;Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.&amp;amp;#34;&amp;lt;/a&amp;gt; Rockville, Maryland.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Hogg, R.; Althoff, K.; Samji, H.; et al. &amp;lt;a href=&amp;quot;http://pag.ias2013.org/Abstracts.aspx?AID&amp;amp;#61;2451&amp;quot; rel=&amp;quot;nofollow&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;externalLink&amp;quot; data-ordinal=&amp;quot;31&amp;quot;&amp;gt;Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007.&amp;amp;#34;&amp;lt;/a&amp;gt; 7th International AIDS Society (IAS) Conference on Pathogenesis, Treatment and Prevention. Kuala Lumpur, Malaysia. June 30-July 3, 2013; Abstract TUPE260.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Skarbinski, J.; Furlow-Parmley, C.; and Frazie, E. &amp;lt;a href=&amp;quot;http://www.retroconference.org/2012b/Abstracts/43173.htm&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;externalLink&amp;quot; data-ordinal=&amp;quot;32&amp;quot;&amp;gt;&amp;amp;#34;Nationally Representative Estimates of the Number of HIV&amp;amp;#43; Adults who Received Medical Care, Were Prescribed ART, and Achieved Viral Suppression-Medical Monitoring Project, 2009 to 2010-US.&amp;amp;#34;&amp;lt;/a&amp;gt; 19th Conference on Retroviruses and Opportunistic Infections (CROI); Seattle, Washington; March 8, 2013; oral abstract #138.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Lasry, A; Sansom, S.; \u00A0Wolitski,R.; et al. &amp;lt;a href=&amp;quot;http://www.ncbi.nlm.nih.gov/pubmed/24804859&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;externalLink&amp;quot; data-ordinal=&amp;quot;33&amp;quot;&amp;gt;&amp;amp;#34;HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies.&amp;amp;#34;&amp;lt;/a&amp;gt; &amp;lt;em&amp;gt;AIDS&amp;lt;/em&amp;gt;. June 14, 2014; 28(10):1521-1529.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Kitahata, M.; Gange, S.; Abraham, A., et al. &amp;lt;a href=&amp;quot;http://www.nejm.org/doi/full/10.1056/NEJMoa0807252%20&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;externalLink&amp;quot; data-ordinal=&amp;quot;34&amp;quot;&amp;gt;&amp;amp;#34;Effect of early versus deferred antiretroviral therapy for HIV on survival.&amp;amp;#34;&amp;lt;/a&amp;gt; &amp;lt;em&amp;gt;New England Journal of Medicine.&amp;lt;/em&amp;gt; April 30, 2009; 360(18):1815-1826.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;"^^<http://www.w3.org/2001/XMLSchema#string>
<https://www.verywell.com/guidelines-for-starting-hiv-therapy-in-adults-49620>