The Department of Health and Human Services recently updated its antiretroviral treatment and opportunistic infection guidelines, reflecting the effectiveness of modern treatment but acknowledging that challenges remain for some people living with HIV.

The Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV now say that dolutegravir (in Tivicay, Triumeq, Dovato and Juluca) can be prescribed for people of childbearing potential, after research confirmed that the risk of neural tube birth defects in infants born to women taking the drug is low.

For treatment optimization, the guidelines include information on the new long-acting injectable regimen Cabenuva (cabotegravir/rilpivirine). The Food and Drug Administration recently approved a once-monthly regimen, and every-other-month dosing is under consideration.

For people unable to maintain an undetectable viral load on their current treatment, a new regimen should include two fully active drugs, including one with a high barrier to resistance. The guidelines also discuss options for managing inadequate CD4 T-cell recovery and persistent inflammation despite viral suppression.

The section on women features information on weight gain after starting or switching treatment and antiretroviral drug interactions with hormone therapy as well as a new subsection on menopause.

The revised Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV include updated information about coccidioidomycosis, bartonellosis and immunizations for people living with HIV.

The guidelines are available at clinicalinfo.hiv.gov/en/guidelines.