Patient handout

HIV — initial evaluation & rapid ART start

PRODUCTION

1. Your condition

This handout is for hiv — initial evaluation & rapid art start. Your care team identified this based on: positive hiv screen (4th-gen ag/ab) + confirmatory (dhhs 2024; cdc 2014 algorithm).

Other reasons your team may use this plan: oi presentation (pcp, candidiasis, ks) without prior diagnosis (dhhs 2024 oi guidelines); mononucleosis-like illness with risk factors (dhhs 2024 — acute hiv); existing hiv without engagement in care (ias-usa 2024 — re-engagement).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
bictegravir-emtricitabine-tenofovir_alafenamide	50/200/25 mg PO daily	PO	daily	DHHS + IAS-USA 2024 — Biktarvy first-line; high barrier to resistance; no HLA-B*5701 needed; minimal DDIs
dolutegravir-lamivudine	50/300 mg PO daily	PO	daily	DHHS + IAS-USA 2024 — Dovato 2-drug regimen; not for HBV+ (3TC monotherapy on HBV)
dolutegravir-abacavir-lamivudine	50/600/300 mg PO daily	PO	daily	DHHS — Triumeq alternative; HLA-B*5701 must be negative (abacavir hypersensitivity) (IDSA 2024)
dolutegravir	50 mg PO daily (50 BID if rifampin)	PO	daily	DHHS + WHO 2024 — DTG safe in pregnancy (Tsepamo / IMPAACT 2010)
cabotegravir-rilpivirine	600/900 mg IM × 1 then 400/600 mg q4-8 weeks	IM	q4-8 weeks	DHHS + IAS-USA 2024 — long-acting maintenance; ATLAS / FLAIR. non_pharm: co-packaged two-ingredient long-acting injectable (Cabenuva) with no single resolving RxNorm ingredient code; prior rxcui 1486991 resolved to glucosamine at RxNav (verified 2026-05-22)

Plan: HIV — first-line ART (DHHS / IAS-USA 2024)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Undetectable / on track (IDSA 2024)

If you have:

Taking ART every day
VL undetectable
CD4 stable or rising
No new symptoms
Vaccinations and STI screens up to date

Do this:

Take ART daily at the same time — never skip doses
Bring all medications and supplements to every visit (DDIs)
Use condoms / prep partner if needed; U=U message — undetectable = untransmittable
Stay current on vaccines (HBV, HPV, pneumococcal, flu, COVID, mpox)
Keep all clinic appointments q3 months

YELLOW — Side effects, missed doses, or new symptoms (IDSA 2024)

If you have:

New diarrhea, weight gain, headache, sleep issues
Missed doses
Started new medication / supplement
New STI symptom or exposure

Do this:

Continue ART unless told otherwise
Call your provider to manage side effect or DDI
Get tested for STIs / TB if exposed
Resume daily dosing without doubling up missed doses

Call your provider if:

More than 2 doses missed in a week
New medication started
Symptoms not improving in 24-48 h

RED — Severe illness — go to ED (IDSA 2024)

If you have:

Severe shortness of breath / chest pain
Severe headache + fever (cryptococcus, lymphoma)
Persistent high fever
Sudden vision change
Confusion / seizure
Severe rash with fever (DRESS, abacavir hypersensitivity)

Do this:

Go to ED immediately
Bring your medication list including ART, OI prophylaxis, supplements
Tell ED you are on ART and your CD4

Call your provider if:

Always seek emergency care for these symptoms

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

PCP, esophageal candidiasis, cryptococcal meningitis, KS, cervical cancer, CMV, lymphoma, MAC, etc. (DHHS 2024 OI guidelines)
CD4 <200 without PCP prophylaxis (DHHS 2024 OI guidelines)
Detectable VL after 6 months on ART OR rebound from suppressed (IDSA 2024)
Worsening symptoms 2-12 weeks after ART start — paradoxical worsening of underlying OI or unmasking (DHHS 2024)
Pregnancy in HIV+ patient (IDSA 2024)
Fever + rash + GI / respiratory / constitutional symptoms within 6 weeks of ABC start (IDSA 2024)(life-threatening)

5. Follow-up

Engagement support, U=U education (PARTNER NEJM 2016), partner PrEP, sexual health, mental health, comorbidity prevention (DHHS 2024)

6. Sources

Guideline: DHHS Adult & Adolescent ART Guidelines (continuously updated, 2025 web edition) + IAS-USA 2024 + WHO 2024 Consolidated HIV Guidelines