The 2018 Recommendations of the International Antiviral Society-USA (IAS-USA) suggests that early treatment in adult HIV patients brings about rapid and more definite decrease in viral load and better care of the patient.

The updated guidelines, written by Michael S. Saag, MD of the University of Alabama at Birmingham and his co-authors, have also revised the drug selection from the previous single-tablet combination to include a three-drug therapy and two-drug switch therapy.  Additionally, cash incentives for treatment have been strongly discouraged. The guidelines were published in JAMA.

A number of studies were conducted to validate the importance of early antiretroviral therapy (ART) ever since the earlier IAS-USA guidelines were published in 2016. The majority of them concluded that immediate medication leads to quick viral suppression. Consequently, the updated guidelines recommended that ART should be started early on (even in the absence of supporting laboratory results), exempting those who are reluctant to start treatment and who are at risk for immune reconstitution syndrome.

Three-drug therapy is recommended for initial treatment selection, which includes a single-strand transfer inhibitor (InSTI) with 2 nucleoside reverse transcriptase inhibitors. Single-tablet combinations are effective, well endured, and encourage medication obedience. Dolutegravir is contraindicated in pregnant women or those who may get pregnant as it may raise the risk of neural tube defects. Two-drug regimens may be thought of as switch therapy to reduce expenditure and complications for initial therapy.

The 2018 guidelines dispirited cash incentives for ART compliance on account of being unproductive while noting that noncash incentives could prove to be favorable. Additional recommendations were extensive and included detection of food shortage or psychiatric disorders among patients.