Guideline

Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV

Year of Publication

2018

Issuing Institution

WHO

Links

Virtual Health Library

Recommendations

13 included recommendations

A dolutegravir (DTG)-based regimen is recommended as the preferred first-line regimen for people living with HIV initiating ART • Adults and adolescents (moderate-certainty evidence) • Women and adolescent girls of childbearing potential (very-low-certainty evidence) • Infants and children with approved DTG dosing (low-certainty evidence)

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A raltegravir (RAL)-based regimen may be recommended as an alternative first-line regimen for infants and children for whom approved dolutegravir (DTG) dosing is not available

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

A raltegravir (RAL)-based regimen is recommended as the preferred first-line regimen for neonates

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

dolutegravir (DTG) in combination with an optimized nucleoside reverse-transcriptase inhibitor backbone is recommended as the preferred second-line regimen for people living with HIVa for whom non-DTGbased regimens are failing

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Moderate

dolutegravir (DTG) in combination with an optimized nucleoside reverse-transcriptase inhibitor backbone is recommended as the preferred second-line regimen for children with approved DTG dosing for whom non-DTG-based regimens are failing

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

An HIV post-exposure prophylaxis regimen with two ARV drugs is effective, but three drugs are preferred

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) or emtricitabine (FTC) is recommended as the preferred backbone regimen for HIV post-exposure prophylaxis

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

dolutegravir (DTG) is recommended as the preferred third drug for HIV post-exposure prophylaxis for children for whom an approved DTG dosing is available

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Adults and adolescents. When available, atazanavir/r (ATV/r), darunavir/r (DRV/r), lopinavir/r (LPV/r) and RAL may be considered as alternative third drug options for post-exposure prophylaxis

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

zidovudine (AZT) + lamivudine (3TC) is recommended as the preferred backbone regimen for HIV post-exposure prophylaxis for children. Abacavir (ABC) + 3TC or tenofovir disoproxil fumarate (TDF) + 3TC or emtricitabine (FTC) can be considered as alternative regimens

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Children. When available, atazanavir/r (ATV/r), darunavir/r (DRV/r), lopinavir/r and RAL may be considered as alternative third drug options for post-exposure prophylaxis

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

An indeterminate range should be used to improve the accuracy of all nucleic acid–based early infant diagnosis assays

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Adults and adolescents. Dolutegravir (DTG) is recommended as the preferred third drug for HIV postexposure prophylaxis

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low