Updated recommendations for ARV therapy

There’s some real weirdness here—“2024 Recommendations of the International Antiviral Society–USA Panel”

The new recommendations for antiretroviral therapy for both “HIV” positive and “HIV” negative individuals have been released; there are some more sub-categories such as ART in pregnancy, or in the presence of opportunistic infections. There’s a lot here, so I won’t go into detail on every aspect of these recommendations, but there are some items of interest I’d like to highlight.

Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel

We begin with some blatant propaganda (emphasis mine throughout):

Because of effective antiretroviral therapy (ART), many people with HIV will live a normal or near-normal lifespan.¹ Management of HIV continues to improve, with increasing options for initial therapy, novel approaches for switching therapy, and effective strategies for managing co-infections. In addition, there are new tools for preventing cardiovascular disease in people with HIV and for reducing the incidence of sexually transmitted infections (STIs). HIV prevention through preexposure prophylaxis (PrEP) remains a dynamic field, with several recent advances. However, improving care of people with HIV who have substance use disorder (SUD) and addressing HIV care disparities remain challenges and high priorities. Here, updated recommendations for HIV treatment and clinical management as well as HIV prevention based on the latest data are provided, and challenges that need additional attention and dedicated resources are highlighted

I bolded the item about cardiovascular events and ART/ARV; we’ve discussed the issues with protease inhibitors and “good Truvada” (TAF) with respect to cardiovascular problems triggered by these medications. I’ve also bolded the part about PrEP, because as we know, the AIDS activist community and the pharmaceutical companies are very eager to double their customer base by trying to prescribe PrEP—which, might I remind you, is the prescription of toxic anti-HIV chemotherapy to “HIV” negative individuals—to a patient population of those “at risk,” estimated in the U.S. to be about 1.2 million, 0.1 million fewer than those estimated to be “HIV” positive. Let’s move on to their medication recommendations.

We begin with the longest section, “ART for individuals with HIV.”

From the introduction, but relevant to this section:

For most people with HIV, initial regimens composed of an integrase strand transfer inhibitor (InSTI), specifically bictegravir or dolutegravir, with 2 (and in some cases 1) nucleoside or nucleotide reverse transcriptase inhibitors are recommended. Recommendations are made for those with particular clinical circumstances, such as pregnancy and active opportunistic diseases, as well as for those unable to take InSTIs.

Once again, it’s fascinating to me that the protease inhibitors—lauded by 1996 as “proof of concept” for the HIV AIDS story—are completely missing from prescriptions; they seem to be replaced with the integrase inhibitors, but it’s unclear what’s so special about these integrase inhibitors. They certainly haven’t been touted as “proof of concept.” And again, the other one or two drugs used in combination are either NRTIs or NNRTIs; in other words, DNA chain terminators, which kill all living cells.

The following excerpt from Box 2 is VERY interesting:

Persons who acquired HIV while receiving preexposure prophylaxis with TAF/FTC or TDF/FTC should have a blood sample for genotyping drawn prior to initiating therapy and a 3-drug regimen, preferably dolutegravir or bictegravir plus TXF/XTC, should be initiated if ART is to be started before genotype results are available (evidence rating: AIII).

You guys—I thought PrEP was perfect. I thought PrEP failures were “rare,” yet they warrant an entire section in this paper. Also, as I’ve been saying for some time, the PrEP pyramid scheme is really remarkable—give you drugs to “prevent HIV,” and then when you test positive, they sell you MORE drugs! I’m honestly impressed with the delusional level of self assurance these people must have to continue to attempt to—often successfully—pull the wool over patients’ eyes.

There’s discussion about ART in pregnancy, but it’s not that interesting; as you can imagine, it is highly encouraged. “Immediate initiation of ART is recommended for all individuals with HIV who are pregnant for reasons of maternal health and to prevent perinatal and sexual transmission.” Again, when I was pregnant, I was discouraged from taking anything stronger than Tylenol. The fact that they’re prescribing these drugs—and especially for PrEP—to pregnant women is concerning. I also don’t love the gender-neutral language, but never mind.

When it comes to the use of ART in the presence of OIs, this is actually quite interesting because immune reconstitution and inflammatory syndrome (IRIS—the development of “paradoxical” OIs after starting ART) is mentioned. It seems that the general consensus is to treat the OI first; then initiate ART two weeks later.

We then move on to “HIV” in cancer. Here’s a quote; I won’t comment on it but rather ask what you think of this.

As deaths from AIDS-defining diseases have declined in people with HIV, there has been an increase in the proportion of deaths due to cancer.^20,21 People with HIV have an increased incidence of non–AIDS-defining malignancies, primarily due to factors such as smoking, alcohol consumption, and low CD4⁺ cell counts.²² Cancer presently contributes to 20% to 30% of all HIV-related deaths^23,24; therefore, prioritizing cancer screening, including for cervical and anal cancer, in people with HIV is recommended (evidence rating: AIa).¹¹

How is it “non-AIDS-defining” when it might be caused by low CD4+ counts, the hallmark of AIDS?

Also, we’re back to the old Covid trick of “dying of” versus “dying with.” Also, here’s a funny line: “Some cancer treatments may be associated with a decline in CD4⁺ cell count, even in individuals stable while receiving ART.” You don’t say—toxic cancer chemotherapy is associated with immune dysfunction? Alert the presses!

I won’t go into the whole switching regimes section, only to highlight a few reasons for switching; the first being “switching in the presence of virologic suppression,” meaning that the medication was effective in decreasing “viral load,” but the side effects were troubling enough to switch, or worse.

The next topic is “switching therapy with blips, low level viremia, or virologic failure,” the wording of which somehow amuses me. The conclusions are underwhelming; they recommend long acting injectables,” presumably because that would increase “adherence.” Makes you wonder how much they trust patients, despite the overbearing attitude of so many (NOT ALL) providers.

There is a long section on “Definition and management of virologic failure;” both in the context of failure due to non-adherence, as well as failure for adherent patients. For reference, “virologic failure” is defined as follows: “Virologic failure occurs when ART fails to achieve or maintain an HIV RNA level below 200 copies/mL.”

Given that we know that viral load, using PCR, amplifies HIV-associated genetic material by many orders of magnitude, and that even by the mainstream’s own admission, it overestimates “viremia” by a factor of at least 60,000, 200 copies sounds pretty trivial and possibly the result of replication error during the PCR process.

There’s an interesting section on weight gain & cardiovascular events, which may have been the nail in the coffin for protease inhibitors, and may prove to be a problem for other “anti-HIV” medications. Of course, they recommend statins, piling toxic drug onto toxic drug. It’s actually disturbing that the discussion of statins continues for paragraphs. Also, regarding “good Truvada:”

Greater weight gain with regimens containing tenofovir alafenamide than with those containing tenofovir disoproxil fumarate also has been observed.

We’ve discussed this before.

There’s a section on substance use, but this is long enough already, and it isn’t really relevant to this discussion, so feel free to check it out at the link.

Finally, we get to the section on “Prevention.” Surprise, surprise—it’s effectively an advertisement for PrEP. They also discuss DoxyPEP and DoxyPrEP—what could possibly go wrong, prescribing antibiotics prophylactially along with ARVs for people with no hint of “HIV” associated genetic material?

The language around “adherence” is creepy as well. “Individuals with high likelihood of HIV exposure are also among the most challenged by adhering to and persisting with PrEP medication and services.” Maybe because they have grown up marinating in a culture that is rightfully suspicious of experimental medical interventions, and that gives them pause.

I’m exhausted already, so I’ll finish by saying the discussion of “future directions” spent a lot of time on the long-acting injectables, which honestly seems completely consistent with the whole HIV AIDS “treatment” model, which is to make it as easy as possible to be “retained in care,” no matter the danger to your health. If a pill a day causes problems, you can at least stop. But what happens if you have an adverse reaction to a bimonthly, or every 6 months, injection? How screwed are you then?

That’s about all the news that’s fit to print on this topic. As always, sound off in the comments.