The Department of Health and Human Services (DHHS) is the U.S. federal government agency responsible for protecting the health of the American public.

The DHHS HIV guidelines help inform healthcare professionals of the best ways to treat HIV based on the latest clinical evidence and expert opinions.

In this article, we break down some of the key points of the DHHS guidelines and what to know about the most recent changes.

The main goal of the DHHS guidelines is to offer recommendations to healthcare professionals on the best treatment options for people with HIV. The guidelines are written and updated based on the most recent scientific evidence.

Doctors and healthcare professionals can consult these guidelines to determine the right treatment at various stages of HIV. For example, the guidelines provide recommendations on when to start antiretroviral therapy (ART), which drugs should be used, and what to do if initial treatment isn’t working.

The full guidelines provide a long list of recommendations you can read here. We’ve summarized some key points below so you can get an idea of the type of information these guidelines include.

Drugs when starting treatment

  • ART is recommended for all people with HIV to lower the chances of severe illness, death, and transmission.
  • People with a new diagnosis of HIV should start ART as soon as possible.
  • Genetic testing is recommended at the beginning of treatment to screen for potential drug resistance.
  • Medical professionals should discuss future pregnancy plans with people who are able to become pregnant. A pregnancy test may be performed before starting HIV treatment.

Preventing sexual transmission

  • People with HIV should be told that keeping their plasma HIV viral load under 200 copies per milliliter (mL) prevents sexual transmission of HIV.
  • To avoid transmission to a sexual partner, people starting ART should use a barrier method, such as a condom, for at least the first 6 months of treatment and until they have a viral load under 200 copies per mL.
  • If a person’s viral load rises to more than 200 copies per mL, a barrier method should be used until the virus is resuppressed.
  • People should be told that keeping a viral load under 200 copies per mL doesn’t stop the transmission of other sexually transmitted infections.

Types of drugs

Initial HIV treatment generally consists of two medications called nucleoside reverse transcriptase inhibitors in combination with a third active antiretroviral (ARV) drug from one of three drug classes:

  1. integrase strand transfer inhibitors
  2. nonnucleoside reverse transcriptase inhibitors
  3. protease inhibitors with a pharmacokinetic enhancer

The following drug regimens are classified as “recommended initial regimens for most people with HIV.” A slash (/) between medications means they’re available as a combination drug within the same pill:

  • bictegravir/tenofovir alafenamide/emtricitabine
  • dolutegravir/abacavir/lamivudine in people without the HLA-B*5701 gene and without chronic hepatitis B infection
  • dolutegravir and either emtricitabine or lamivudine, and tenofovir alafenamide or tenofovir disoproxil fumarate
  • dolutegravir/lamivudine, except for people with a viral load greater than 500,000 copies per mL or with chronic hepatitis B infection; also not suitable if ART is started before receiving genetic testing results

Treatment failure

When ART isn’t working, several factors should be considered, including:

  • drug-drug interactions
  • drug-food interactions
  • drug tolerability
  • HIV viral load
  • CD4 cell count
  • ART history
  • results of drug resistance tests
  • sticking to a treatment plan

Specific patient groups

  • ART is recommended for all adolescents and young adults to lower the chances of severe symptoms, early death, and transmission.
  • ART is recommended for all transgender people.
  • ART is especially important for older adults because they have a greater risk of non-AIDS complications and don’t generally respond as well to ART as younger people.
  • Substance use disorders are common among people with HIV and can contribute to poor outcomes. Screening should be a regular part of care. The most common substances to screen for include:
    • alcohol
    • benzodiazepines
    • cannabis
    • opioids
    • cocaine
    • methamphetamines
    • tobacco

Women

  • When prescribing ARV drugs to women, healthcare professionals should consider that some ARV drugs interact with hormonal birth control.
  • Healthcare professionals should consider that weight gain is possible for this group. If obesity is a concern, healthcare professionals should factor that into the treatment choice.

At the time this article was written, the DHHS guidelines were most recently updated on January 20, 2022.

Researchers are continuing to improve their understanding of how to best treat and manage HIV. The guidelines are updated periodically to include the latest research and expert opinions.

Here’s an overview of the most recent changes included in the 2022 update.

Early HIV

A section of the guidelines regarding false-positive test results was updated. In the previous version, the Panel on Antiretroviral Guidelines for Adults and Adolescents explained that a person suspected of having acute HIV with an HIV RNA level of less than 10,000 copies/mL may receive a false-positive.

The panel updated this information to note that HIV RNA tests are very specific and sensitive in people who have been exposed to the virus or are experiencing symptoms. Because of this, a low HIV RNA concentration of less than 3,000 copies/mL (for example) could still be acute HIV despite showing up as negative or undetermined.

In certain rare cases, an HIV RNA test may have a concentration of less than 3,000 copies/mL and show up as a false-positive.

It’s important that repeat testing is done in these situations to make sure a person is receiving the correct diagnosis.

The updated guidelines also added more information to the section describing acute HIV diagnoses among people who are receiving pre-exposure prophylaxis followed by ART.

Discontinued or interrupted ART

The updated guidelines now include information on discontinuation or interruption of long-acting ART, such as ibalizumab and the intramuscular formulations of cabotegravir and rilpivirine.

The update also explains the necessary steps to be taken before and during ART interruption for people who have HIV and are participating in a clinical trial where treatment interruptions occur.

There are many free or low-cost programs available to help people with HIV. Here are some resources that may be helpful:

The DHHS HIV guidelines were developed to help healthcare professionals stay up to date with the latest HIV research so they can provide the best possible treatment. The guidelines are updated regularly as new research or evidence becomes available.

The guidelines are available online for free to anybody who wants to read them.