Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society–USA Panel

Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society-USA Panel. JAMA. 2022; doi:10.1001/jama.2022.22246. [epublished online December 1, 2022]


Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice.


Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.

Evidence Review

A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.


Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option.Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential.

Conclusions and Relevance

Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.


Rajesh T. Gandhi, MD
Harvard Medical School

Roger J. Bedimo, MD
University of Texas Southern Medical Center

Jennifer F. Hoy, MBBS, FRACP
Monash University

Raphael J. Landovitz, MD
University of California Los Angeles

Davey M. Smith, MD
University of California San Diego

Ellen F. Eaton, MD
University of Alabama at Birmingham

Clara Lehmann, MD
German Center For Infectious Research (DZIF)

Sandra A. Springer, MD
Yale University

Paul E. Sax, MD
Harvard Medical School

Melanie A. Thompson, MD
AIDS Research Consortium of Atlanta

Constance A. Benson, MD
University of California San Diego

Susan P. Buchbinder, MD
University of California San Francisco

Carlos del Rio, MD
Emory University School of Medicine

Joseph J. Eron Jr, MD
The University of North Carolina at Chapel Hill

Huldrych F. Günthard, MD
University Hospital Zurich

Jean-Michel Molina, MD
University of Paris Diderot

Donna M. Jacobsen, BS
International Antiviral Society-USA

Michael S. Saag, MD
University of Alabama at Birmingham