Antiretrovirals - Revision history

Danbot: Reduce excessive bold: 27 -> 18 instances

2026-03-22T08:46:18Z

Reduce excessive bold: 27 -> 18 instances

Danbot: Formatting: moved intro, removed bold

2026-03-19T16:17:43Z

Formatting: moved intro, removed bold

Show changes

Ostermayer: /* See Also */

2026-03-10T23:27:30Z

Ostermayer: Created page with " ==Background== Antiretrovirals (ARVs) are medications used for treatment and prevention of HIV infection. Emergency physicians most commonly encounter ARVs in the context of post-exposure prophylaxis (PEP), managing patients on chronic antiretroviral therapy (ART), and recognizing drug interactions or adverse effects. '''ART should never be discontinued in the ED'''..."

2026-03-10T17:39:25Z

Created page with "<languages/> <translate> ==Background== Antiretrovirals (ARVs) are medications used for treatment and prevention of HIV infection. Emergency physicians most commonly encounter ARVs in the context of post-exposure prophylaxis (PEP), managing patients on chronic antiretroviral therapy (ART), and recognizing drug interactions or adverse effects. '''ART should never be discontinued in the ED'''..."

New page

<languages/>
<translate>

==Background==

Antiretrovirals (ARVs) are medications used for treatment and prevention of [[Special:MyLanguage/HIV|HIV]] infection. Emergency physicians most commonly encounter ARVs in the context of [[Special:MyLanguage/HIV post-exposure prophylaxis|post-exposure prophylaxis (PEP)]], managing patients on chronic antiretroviral therapy (ART), and recognizing drug interactions or adverse effects. '''ART should never be discontinued in the ED''' — interrupting therapy risks viral rebound, immune reconstitution failure, and development of drug resistance.<ref name="IAS2024">Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2025;333(7):609-628. doi:10.1001/jama.2024.24543</ref>

===Drug Classes===

{| class="wikitable"
|-
! Class !! Abbreviation !! Mechanism !! Common Examples
|-
| Nucleoside/Nucleotide Reverse Transcriptase Inhibitors || NRTIs || Inhibit HIV reverse transcriptase (chain terminators) || [[Special:MyLanguage/Tenofovir|Tenofovir]] (TDF/TAF), [[Special:MyLanguage/Emtricitabine|emtricitabine]] (FTC), [[Special:MyLanguage/Lamivudine|lamivudine]] (3TC), [[Special:MyLanguage/Abacavir|abacavir]] (ABC), [[Special:MyLanguage/Zidovudine|zidovudine]] (AZT)
|-
| Non-Nucleoside Reverse Transcriptase Inhibitors || NNRTIs || Bind and inhibit reverse transcriptase allosterically || [[Special:MyLanguage/Efavirenz|Efavirenz]] (EFV), rilpivirine (RPV), doravirine (DOR)
|-
| Protease Inhibitors || PIs || Block HIV protease, preventing viral maturation || [[Special:MyLanguage/Darunavir|Darunavir]] (DRV), atazanavir (ATV); always given with [[Special:MyLanguage/ritonavir|ritonavir]] or cobicistat boosting
|-
| Integrase Strand Transfer Inhibitors || INSTIs || Block integration of viral DNA into host genome || Bictegravir (BIC), [[Special:MyLanguage/Dolutegravir|dolutegravir]] (DTG), [[Special:MyLanguage/Raltegravir|raltegravir]] (RAL), cabotegravir (CAB)
|-
| Entry/Fusion Inhibitors || — || Block HIV entry into host cells || [[Special:MyLanguage/Maraviroc|Maraviroc]] (CCR5 antagonist), enfuvirtide (fusion inhibitor), [[Special:MyLanguage/Lenacapavir|lenacapavir]] (capsid inhibitor)
|}

===Current Preferred Regimens (2024-2025)===

Most patients on ART will be taking an '''INSTI-based regimen''', typically as a single-tablet regimen (STR):<ref name="IAS2024"/><ref name="WHO2026">WHO. Updated recommendations on HIV clinical management. January 7, 2026. https://www.who.int/news/item/07-01-2026-who-releases-updated-recommendations-on-hiv-clinical-management</ref>

*'''Bictegravir/emtricitabine/tenofovir alafenamide''' (Biktarvy) — most commonly prescribed STR
*'''Dolutegravir/lamivudine''' (Dovato) — 2-drug regimen for select patients
*'''Dolutegravir/abacavir/lamivudine''' (Triumeq) — requires HLA-B*5701 testing prior to initiation
*'''Cabotegravir/rilpivirine''' (Cabenuva) — long-acting injectable given monthly or every 2 months

==Administration==

*Type: [[Special:MyLanguage/antiviral|Antiviral]] (multiple drug classes; see table above)
*Dosage Forms: Oral tablets/capsules (most common as fixed-dose single-tablet regimens), oral solutions, long-acting injectables (cabotegravir/rilpivirine, lenacapavir)
*Routes of Administration: PO (most), IM/SC (long-acting formulations), IV (enfuvirtide, zidovudine)
*Common Trade Names: Biktarvy (BIC/FTC/TAF), Dovato (DTG/3TC), Triumeq (DTG/ABC/3TC), Genvoya (EVG/COBI/FTC/TAF), Cabenuva (CAB/RPV LA), Sunlenca (lenacapavir)

==Adult Dosing==

===HIV Post-Exposure Prophylaxis (PEP) — The Key ED Indication===

'''Initiate as soon as possible, ideally within 24 hours, and no later than 72 hours after exposure.'''<ref name="CDCnPEP2025">Tanner MR, O'Shea JG, Byrd KM, et al. Antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV — CDC recommendations, United States, 2025. MMWR Recomm Rep. 2025;74(1):1-56.</ref><ref name="oPEP2025">2025 US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-exposure Prophylaxis in Healthcare Settings. Infect Control Hosp Epidemiol. 2025.</ref>

'''Duration: 28 days'''

'''Preferred regimens (adults and adolescents):'''<ref name="CDCnPEP2025"/>
*'''Bictegravir/emtricitabine/tenofovir alafenamide''' (Biktarvy) — 1 tablet PO daily ('''preferred single-tablet regimen''')
*'''Dolutegravir 50 mg PO daily''' PLUS tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) PLUS emtricitabine (FTC) or lamivudine (3TC)

'''Alternative regimen (when INSTIs unavailable or contraindicated):'''
*'''Darunavir/cobicistat''' (Prezcobix) 1 tab PO daily PLUS emtricitabine/tenofovir (Truvada or Descovy) 1 tab PO daily
*'''Raltegravir''' 400 mg PO BID PLUS emtricitabine/tenofovir (Truvada or Descovy) 1 tab PO daily

'''Do NOT delay the first dose for lab results''' — give in the ED and arrange follow-up<ref name="CDCnPEP2025"/>

'''PEPline for expert consultation: 1-888-448-4911'''

===HIV Treatment===

*Dosing is regimen-specific; do not modify, hold, or restart a patient's ART regimen in the ED without specialist consultation
*If a patient cannot take oral medications (e.g., intubated, NPO for surgery), consult HIV specialist urgently — treatment interruption decisions must balance resistance risk

==Pediatric Dosing==

===HIV PEP (Pediatric)===

*'''Age ≥2 years and ≥25 kg:''' Biktarvy (BIC/FTC/TAF) — weight-based dosing available in pediatric tablets<ref name="CDCnPEP2025"/>
*'''Age ≥4 weeks and ≥3 kg:''' Dolutegravir (weight-based) PLUS age-appropriate NRTI backbone (FTC/TAF or AZT/3TC for neonates)
*'''Neonates (<4 weeks):''' Consult pediatric ID specialist; regimens vary by age and weight
*'''PEPline: 1-888-448-4911''' for pediatric dosing assistance

===HIV Treatment (Pediatric)===

*Dosing is weight-based and regimen-specific; managed by pediatric HIV specialists
*Do not modify regimens in the ED

==Special Populations==

===[[Special:MyLanguage/Drug pregnancy categories|Pregnancy]]===

*ART should be continued throughout pregnancy to prevent vertical transmission<ref name="IAS2024"/>
*'''Preferred agents in pregnancy:''' Dolutegravir-based regimens (previously avoided in first trimester due to neural tube defect concern; now recommended based on larger safety data)<ref name="IAS2024"/>
*'''Avoid:''' Efavirenz (teratogenicity concern); oral solutions containing alcohol/propylene glycol
*For PEP in pregnancy: Preferred regimen is raltegravir + emtricitabine/tenofovir (Truvada); dolutegravir is also acceptable<ref name="CDCnPEP2025"/>
*Consult OB/ID for management of HIV-positive pregnant patients in the ED

===Lactation===

*In the United States, women with HIV are advised '''not to breastfeed''' regardless of viral load (per US guidelines)<ref name="IAS2024"/>
*WHO guidelines differ — in resource-limited settings, breastfeeding while on suppressive ART is recommended<ref name="WHO2026"/>

===Renal Dosing===

*'''Tenofovir disoproxil fumarate (TDF):''' Requires dose adjustment with CrCl <50 mL/min; avoid if CrCl <30 mL/min
*'''Tenofovir alafenamide (TAF):''' No adjustment needed unless CrCl <15 mL/min and not on dialysis
*'''Dolutegravir, bictegravir, raltegravir:''' No renal adjustment needed
*'''Emtricitabine, lamivudine:''' Require dose adjustment with CrCl <50 mL/min
*Consult specific drug labeling or HIV pharmacist for complex renal impairment

===Hepatic Dosing===

*'''Most NRTIs:''' No adjustment (renally eliminated)
*'''Protease inhibitors (PIs):''' Hepatically metabolized; use with caution, contraindicated in severe impairment
*'''NNRTIs:''' Variable; efavirenz and rilpivirine should be avoided in severe hepatic impairment
*'''INSTIs:''' Generally no adjustment needed for mild-moderate impairment; limited data in severe impairment
*'''Abacavir:''' Contraindicated in moderate-severe hepatic impairment (hepatically metabolized)

==Contraindications==

*Allergy to specific drug/class
*'''Abacavir:''' Contraindicated if '''HLA-B*5701 positive''' (risk of fatal hypersensitivity reaction — do NOT restart after suspected reaction)<ref name="IAS2024"/>
*'''Tenofovir DF (TDF):''' Avoid in significant renal impairment (CrCl <30 mL/min)
*'''Protease inhibitors:''' Multiple contraindicated co-medications due to CYP3A4 inhibition (see Drug Interactions)
*'''Dofetilide, flecainide, amiodarone:''' Contraindicated with boosted PIs

==Drug Interactions (Critical for ED Practice)==

{| class="wikitable"
|-
! ARV Class !! Key Interaction Mechanism !! ED-Critical Interactions
|-
| '''Boosted PIs''' (darunavir/r, atazanavir/r) || Potent CYP3A4 inhibitors || '''Contraindicated:''' oral midazolam, triazolam, ergotamines, simvastatin, lovastatin, amiodarone, flecainide. '''Caution:''' fentanyl (increased levels), methadone (decreased levels), warfarin, direct oral anticoagulants
|-
| '''Cobicistat''' (in Genvoya, Prezcobix) || CYP3A4 inhibitor (pharmacokinetic booster) || Same as boosted PIs above; also inhibits tubular creatinine secretion (raises creatinine without true GFR change)
|-
| '''INSTIs''' (dolutegravir, bictegravir, raltegravir) || Chelation with polyvalent cations || '''Separate from antacids, calcium, iron, magnesium by ≥2 hours''' (reduced absorption). Few other significant interactions — INSTIs are the safest class for drug interactions
|-
| '''NNRTIs''' (efavirenz, rilpivirine) || CYP3A4 inducers (efavirenz) or substrates || Efavirenz decreases methadone levels. Rilpivirine: avoid PPIs (reduced absorption); H2-blockers must be given 12 hours before or 4 hours after
|-
| '''NRTIs''' || Minimal CYP interactions || Tenofovir: avoid with nephrotoxic drugs. Zidovudine: additive hematologic toxicity with other myelosuppressive drugs
|}

'''ED Pearl:''' If a patient on ART needs procedural sedation, '''IV midazolam may be used cautiously''' with boosted PIs (with dose reduction and monitoring), but '''oral midazolam is contraindicated'''. Propofol, ketamine, and etomidate have no significant ARV interactions and are safe choices.

==Adverse Reactions==

===Serious (Class-Specific)===

*'''Abacavir hypersensitivity reaction:''' Fever, rash, GI symptoms, respiratory symptoms within first 6 weeks. '''NEVER rechallenge''' — can be fatal. Prevented by HLA-B*5701 screening<ref name="IAS2024"/>
*'''Lactic acidosis/hepatic steatosis:''' NRTIs (especially older agents: stavudine, didanosine; rare with current agents)
*'''Tenofovir DF (TDF) nephrotoxicity:''' Fanconi syndrome, acute kidney injury, decreased bone mineral density
*'''[[Special:MyLanguage/Immune reconstitution syndrome|Immune reconstitution inflammatory syndrome]] (IRIS):''' Paradoxical worsening of preexisting infections (TB, MAC, CMV, PML, cryptococcus) after ART initiation; typically within first 4-8 weeks
*'''QT prolongation:''' Rilpivirine, PIs (especially with other QT-prolonging agents)
*'''Hepatotoxicity:''' NNRTIs (nevirapine > efavirenz), PIs; risk increased with hepatitis B/C co-infection
*'''[[Special:MyLanguage/Stevens-Johnson syndrome|Stevens-Johnson syndrome]] / [[Special:MyLanguage/Toxic epidermal necrolysis|TEN]]:''' NNRTIs (nevirapine, efavirenz), abacavir
*'''Hepatitis B flare:''' Discontinuation of tenofovir, emtricitabine, or lamivudine (which have dual HIV/HBV activity) may trigger severe '''HBV reactivation''' — another reason not to stop ART in the ED<ref name="IAS2024"/>

===Common===

*'''GI effects:''' Nausea, diarrhea, abdominal pain (most common with PIs; common reason for PEP nonadherence)
*'''CNS effects:''' Insomnia, vivid dreams, dizziness, depression (efavirenz; also reported with dolutegravir and bictegravir)
*'''Weight gain:''' INSTIs (especially dolutegravir, bictegravir) and TAF-containing regimens<ref name="IAS2024"/>
*'''Metabolic:''' Hyperlipidemia, insulin resistance (especially PIs)
*'''Rash:''' NNRTIs, abacavir
*'''Elevated creatinine (non-pathologic):''' Cobicistat and dolutegravir inhibit tubular creatinine secretion — creatinine rises ~0.1-0.15 mg/dL without true GFR change. Do NOT reflexively hold ART for this

==Pharmacology==

*Half-life: Varies widely by class; oral agents typically 5-20 hours; long-acting injectables (cabotegravir, lenacapavir) have effective half-lives of weeks to months
*Metabolism: NRTIs — primarily renal; NNRTIs and PIs — primarily hepatic (CYP450); INSTIs — hepatic (UGT1A1) with renal component
*Excretion: Class-dependent (see above)

==Mechanism of Action==

Each class targets a different step in the HIV replication cycle:
*'''NRTIs:''' Incorporated into growing viral DNA chain by reverse transcriptase, causing chain termination
*'''NNRTIs:''' Bind directly to reverse transcriptase at an allosteric site, altering enzyme conformation
*'''PIs:''' Block HIV protease from cleaving Gag-Pol polyprotein precursors into functional viral proteins
*'''INSTIs:''' Block integrase enzyme from inserting viral DNA into the host cell genome
*'''Entry/Fusion inhibitors:''' Block viral attachment (CCR5 antagonists), membrane fusion, or capsid assembly at various pre-integration steps

==Comments==

===Key ED Pearls===

*'''Never stop ART''' — even temporarily. Risk of viral rebound, HBV flare (if co-infected), resistance development. If oral route unavailable, consult HIV specialist urgently
*'''PEP is time-sensitive''' — give the first dose in the ED, do not wait for labs. Biktarvy (1 tab daily × 28 days) is the simplest preferred regimen<ref name="CDCnPEP2025"/>
*'''IRIS is not treatment failure''' — it is a sign of immune recovery. Treat the underlying OI, continue ART. Consider steroids for severe IRIS after ID consultation
*'''Abacavir reaction = never rechallenge.''' Even if prior reaction was mild.
*'''Procedural sedation:''' Avoid oral midazolam with PIs/cobicistat. Propofol, ketamine, etomidate are safe alternatives
*'''PEP to PrEP transition:''' For patients with ongoing HIV risk, link PEP patients to PrEP after completing the 28-day course<ref name="CDCnPEP2025"/>
*'''Expert consultation:''' PEPline — '''1-888-448-4911''' (National Clinician Consultation Center; available 7 days/week)

==See Also==

*[[Special:MyLanguage/HIV|HIV]]
*[[Special:MyLanguage/HIV post-exposure prophylaxis|HIV post-exposure prophylaxis]]
*[[Special:MyLanguage/Pre-exposure prophylaxis|Pre-exposure prophylaxis (PrEP)]]
*[[Special:MyLanguage/Immune reconstitution syndrome|Immune reconstitution inflammatory syndrome]]
*[[Special:MyLanguage/Opportunistic infections in HIV|Opportunistic infections in HIV]]

==References==
{{Reflist|2}}
[[Category:Pharmacology]]
</translate>

← Older revision		Revision as of 08:46, 22 March 2026
Line 26:		Line 26:
	===Current Preferred Regimens (2024-2025)===		===Current Preferred Regimens (2024-2025)===

	Most patients on ART will be taking an ~~'''~~INSTI-based regimen~~'''~~, typically as a single-tablet regimen (STR):<ref name="IAS2024"/><ref name="WHO2026">WHO. Updated recommendations on HIV clinical management. January 7, 2026. https://www.who.int/news/item/07-01-2026-who-releases-updated-recommendations-on-hiv-clinical-management</ref>		Most patients on ART will be taking an INSTI-based regimen, typically as a single-tablet regimen (STR):<ref name="IAS2024"/><ref name="WHO2026">WHO. Updated recommendations on HIV clinical management. January 7, 2026. https://www.who.int/news/item/07-01-2026-who-releases-updated-recommendations-on-hiv-clinical-management</ref>

	*Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) — most commonly prescribed STR		*Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) — most commonly prescribed STR
Line 44:		Line 44:
	===HIV Post-Exposure Prophylaxis (PEP) — The Key ED Indication===		===HIV Post-Exposure Prophylaxis (PEP) — The Key ED Indication===

	~~'''~~Initiate as soon as possible, ideally within 24 hours, and no later than 72 hours after exposure.~~'''~~<ref name="CDCnPEP2025">Tanner MR, O'Shea JG, Byrd KM, et al. Antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV — CDC recommendations, United States, 2025. MMWR Recomm Rep. 2025;74(1):1-56.</ref><ref name="oPEP2025">2025 US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-exposure Prophylaxis in Healthcare Settings. Infect Control Hosp Epidemiol. 2025.</ref>		Initiate as soon as possible, ideally within 24 hours, and no later than 72 hours after exposure.<ref name="CDCnPEP2025">Tanner MR, O'Shea JG, Byrd KM, et al. Antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV — CDC recommendations, United States, 2025. MMWR Recomm Rep. 2025;74(1):1-56.</ref><ref name="oPEP2025">2025 US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-exposure Prophylaxis in Healthcare Settings. Infect Control Hosp Epidemiol. 2025.</ref>

	~~'''~~Duration: 28 days~~'''~~		Duration: 28 days

	~~'''~~Preferred regimens (adults and adolescents):~~'''~~<ref name="CDCnPEP2025"/>		Preferred regimens (adults and adolescents):<ref name="CDCnPEP2025"/>
	*Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) — 1 tablet PO daily (~~'''~~preferred single-tablet regimen~~'''~~)		*Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) — 1 tablet PO daily (preferred single-tablet regimen)
	*Dolutegravir 50 mg PO daily PLUS tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) PLUS emtricitabine (FTC) or lamivudine (3TC)		*Dolutegravir 50 mg PO daily PLUS tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) PLUS emtricitabine (FTC) or lamivudine (3TC)

Line 58:		Line 58:
	'''Do NOT delay the first dose for lab results''' — give in the ED and arrange follow-up<ref name="CDCnPEP2025"/>		'''Do NOT delay the first dose for lab results''' — give in the ED and arrange follow-up<ref name="CDCnPEP2025"/>

	~~'''~~PEPline for expert consultation: 1-888-448-4911~~'''~~		PEPline for expert consultation: 1-888-448-4911

	===HIV Treatment===		===HIV Treatment===
Line 91:		Line 91:
	===Lactation===		===Lactation===

	*In the United States, women with HIV are advised ~~'''~~not to breastfeed~~'''~~ regardless of viral load (per US guidelines)<ref name="IAS2024"/>		*In the United States, women with HIV are advised not to breastfeed regardless of viral load (per US guidelines)<ref name="IAS2024"/>
	*WHO guidelines differ — in resource-limited settings, breastfeeding while on suppressive ART is recommended<ref name="WHO2026"/>		*WHO guidelines differ — in resource-limited settings, breastfeeding while on suppressive ART is recommended<ref name="WHO2026"/>

Line 148:		Line 148:
	*Hepatotoxicity: NNRTIs (nevirapine > efavirenz), PIs; risk increased with hepatitis B/C co-infection		*Hepatotoxicity: NNRTIs (nevirapine > efavirenz), PIs; risk increased with hepatitis B/C co-infection
	*[[Special:MyLanguage/Stevens-Johnson syndrome\|Stevens-Johnson syndrome]] / [[Special:MyLanguage/Toxic epidermal necrolysis\|TEN]]: NNRTIs (nevirapine, efavirenz), abacavir		*[[Special:MyLanguage/Stevens-Johnson syndrome\|Stevens-Johnson syndrome]] / [[Special:MyLanguage/Toxic epidermal necrolysis\|TEN]]: NNRTIs (nevirapine, efavirenz), abacavir
	*Hepatitis B flare: Discontinuation of tenofovir, emtricitabine, or lamivudine (which have dual HIV/HBV activity) may trigger severe ~~'''~~HBV reactivation~~'''~~ — another reason not to stop ART in the ED<ref name="IAS2024"/>		*Hepatitis B flare: Discontinuation of tenofovir, emtricitabine, or lamivudine (which have dual HIV/HBV activity) may trigger severe HBV reactivation — another reason not to stop ART in the ED<ref name="IAS2024"/>

	===Common===		===Common===
Line 184:		Line 184:
	*Procedural sedation: Avoid oral midazolam with PIs/cobicistat. Propofol, ketamine, etomidate are safe alternatives		*Procedural sedation: Avoid oral midazolam with PIs/cobicistat. Propofol, ketamine, etomidate are safe alternatives
	*PEP to PrEP transition: For patients with ongoing HIV risk, link PEP patients to PrEP after completing the 28-day course<ref name="CDCnPEP2025"/>		*PEP to PrEP transition: For patients with ongoing HIV risk, link PEP patients to PrEP after completing the 28-day course<ref name="CDCnPEP2025"/>
	*Expert consultation: PEPline — ~~'''~~1-888-448-4911~~'''~~ (National Clinician Consultation Center; available 7 days/week)		*Expert consultation: PEPline — 1-888-448-4911 (National Clinician Consultation Center; available 7 days/week)

	==See Also==		==See Also==

← Older revision		Revision as of 23:27, 10 March 2026
Line 189:		Line 189:
	*[[Special:MyLanguage/HIV\|HIV]]		*[[Special:MyLanguage/HIV\|HIV]]
	*[[Special:MyLanguage/HIV post-exposure prophylaxis\|HIV post-exposure prophylaxis]]		*[[Special:MyLanguage/HIV post-exposure prophylaxis\|HIV post-exposure prophylaxis]]
	*[[Special:MyLanguage/Pre-exposure prophylaxis\|Pre-exposure prophylaxis (PrEP)]]		*[[Special:MyLanguage/HIV Pre-exposure prophylaxis\|HIV Pre-exposure prophylaxis (PrEP)]]
	*[[Special:MyLanguage/Immune reconstitution syndrome\|Immune reconstitution inflammatory syndrome]]		*[[Special:MyLanguage/Immune reconstitution syndrome\|Immune reconstitution inflammatory syndrome]]
	*[[Special:MyLanguage/Opportunistic infections in HIV\|Opportunistic infections in HIV]]		*[[Special:MyLanguage/Opportunistic infections in HIV\|Opportunistic infections in HIV]]