Clinical HIV Care: Treatment That Saves Lives

• HIV weakens the immune system by targeting CD4 T cells, making individuals vulnerable to opportunistic infections and certain cancers  
• Prompt initiation of antiretroviral therapy (ART) transforms HIV from a fatal disease into a manageable chronic condition—saving lives  
• Effective ART suppresses the viral load to undetectable levels, enabling the immune system to recover and eliminating the risk of sexual HIV transmission—“Undetectable = Untransmittable (U=U)” . 

1. Combination ART Regimens 

• Standard treatment mixes three or more antiretroviral drugs across two or more classes—such as integrase strand transfer inhibitors (INSTIs), nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), or protease inhibitors—often in a single daily pill format  
• Common regimens include Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)—widely used as first-line therapy due to its efficacy, tolerability, and simplicity. 

2. Long-Acting Injectable ART 

• For patients needing alternatives to daily pills, lenacapavir (Sunlenca) offers an injectable option administered every six months, a first-of-its-kind convenience for treatment-experienced individuals. 
• This can help improve adherence and simplify care for those facing pill fatigue or adherence challenges. 

1. Rapid ART Start 

• Treatment is initiated as soon as HIV is diagnosed—regardless of CD4 count—to improve outcomes and reduce transmission risk  

1. Initial Work-Up 

• Baseline labs include viral load, CD4 count, kidney & liver function, and tests for other infections (hepatitis, STIs). 

1. Regular Monitoring 

• Viral load and CD4 tests every 1–3 months until suppression is achieved, then every 3–6 months to confirm ongoing control. 
• Screen for side effects, adverse drug interactions, and manage comorbidities like diabetes, hypertension, and mental health concerns  

1. Opportunistic Infection (OI) Prevention 

• Prophylaxis for OIs (e.g., PCP, TB) is provided if CD4 counts drop below thresholds, and stopped once the immune system recovers  

1. Holistic Care Approach 

• HIV treatment includes behavioral health, substance use counseling, nutrition, and reproductive health support. 
• Shared decisionmaking ensures treatment aligns with patient lifestyle, values, and goals. 

1. LongTerm Management 

• Ongoing care focuses on nonHIV health screening: heart disease, bone density, cancer, dental health, and overall wellness  
• Care is completely integrated: patients remain connected with trusted providers and community resources. 

• Viral suppression (< 200 copies/mL) and ideally undetectable levels—leading to an effective normal life expectancy. 
• Immune restoration, evidenced by rising CD4 counts, reducing risk of OIs and cancer  
• Prevention of HIV transmission—both sexually and to newborns—through treatment as prevention and U=U  
• Enhanced quality of life: mental, emotional, and social well-being reinforced by psychosocial support.