The recommended standard of HIV care in New York is to initiate antiretroviral therapy on the day of diagnosis or first clinic visit.
You should offer immediate antiretroviral therapy to:
Do not provide immediate HIV treatment to:
For more detailed guidance on clinical steps, challenging scenarios and financial assistance to support immediate HIV treatment, see:
A range of randomized clinical trials found that initiating antiretroviral therapy on the day of diagnosis increases the proportion of patients who were virally suppressed and retained in care after 12 months. Immediate treatment allows patients to engage in HIV care without delay and can empower them to disclose their status to partners, friends and family.
Providers should initiate HIV treatment at the first HIV-related visit while collecting blood for a genotype to test for drug resistance and kidney function, as well as a confirmatory HIV test (if needed). Real-world clinical experience suggests that providers seldom have to stop or alter the initial regimen.
For clinical HIV care support, contact the New York State Clinical Education Initiative Line.
1. Educate and Counsel the Patient
Ultimately, the patient decides if they are ready to start HIV treatment. Providers can help inform this decision by describing the following goal and benefits of HIV treatment:
2. Conduct a Medical Evaluation
If the patient has a prior history of irregularly taking antiretroviral therapy, delay prescribing an initial regimen until you receive a genotype. If the patient has signs or symptoms of severe opportunistic infections, delay therapy until it is safe to initiate.
4. Prescribe an Initial Regimen
Regimens for immediate antiretroviral therapy should not contain abacavir, an NRTI. Due to concern for a life-threatening hypersensitivity reaction, conduct an HLA-B*5701 testing before prescribing abacavir.
5. Ensure Coverage of Care
HIV treatment is available to all New Yorkers. Assess patients for insurance coverage and connect them to any needed financial support for immediate antiretroviral therapy.
See more information on New York State and Pharma patient assistance programs that can support immediate HIV treatment for uninsured and underinsured patients.
6. Address Potential Barriers to Care
On the day of antiretroviral therapy initiation, clinic staff should assess patients for social and psychological stability, including housing status, mental health and substance use.
Encourage patients to contact the clinic if they struggle to take HIV medicines every day.
7. Schedule Follow-up Care
Follow up with the patient to assure adherence to treatment, repeat lab work and possibly adjust the regimen, according to the following schedule