Immediate Initiation of HIV Treatment

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:

  • Patients newly diagnosed with HIV based on either a lab test or a point-of-care HIV test
  • Patients previously diagnosed with HIV who either never received antiretroviral therapy or previously took HIV treatment medicines regularly

Do not provide immediate HIV treatment to:

  • Patients for whom immediate antiretroviral therapy might be medically dangerous, including those with clinical signs or symptoms of cryptococcal meningitis or tubercular meningitis
  • Patients who are likely to have multiple mutations to antiretroviral medicines from prior irregular use of HIV medicines

For more detailed guidance on clinical steps, challenging scenarios and financial assistance to support immediate HIV treatment, see:

Benefits

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.

Clinical Steps

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:

  • Medicines to treat HIV are safe and suppress the HIV in your body.
  • The goal of treatment is to reduce the HIV to an undetectable level, limit damage to your body and immune system and prevent transmission to others.
  • Starting HIV treatment today — and taking medicines as prescribed — will help get the HIV in your body to undetectable as quickly as possible.

2. Conduct a Medical Evaluation

Following federal clinical guidelines and New York State clinical guidelines on the diagnosis and management of HIV, conduct:

  • A standard HIV and general medical history
  • A physical exam
  • Baseline laboratory tests (including a genotype)

3. Contraindications

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

Following federal clinical guidelines and New York State clinical guidelines, select a regimen containing a NRTI and an integrase inhibitor, preferably in a single pill than can be taken once a day.

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

  • A check-in within two to three days using the patient’s preferred method of contact
  • A clinical visit within one to two weeks, after receipt of the genotype
  • A clinical visit at four weeks to get a quantitative viral load
  • Clinical visits about once every three months thereafter, following Federal guidelines (PDF)

Additional Resources

More Information