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HIV ASSIST Guide

CME

How to Use the HIV-ASSIST Tool: A Step-by-Step Guide for HCPs in Asia

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 11, 2025

Expiration: June 10, 2026

Maunank Shah
Maunank Shah, MD, PhD
CME/CE Information

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Case 1: Choosing Initial ART

Let us consider a case example to see how the tool can be applied and used for a few different common situations.

Here, we have a case involving initial ARV selection in a treatment-naive patient. This patient is 52 years of age with no comorbidities or other medications and has just tested positive for HIV for the first time. Baseline test results prior to ART initiation appear in the table here. The CD4+ cell count was 450 cells/mm3, with a HIV-1 RNA of 557,000 copies/mL, and there was no resistance seen on an HIV genotype. Other factors to consider, such as BMI, kidney values, and possible coinfections, are also shown in the table.

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HIV-ASSIST: Input Key Viral and Patient-Specific Factors

The first step in applying the HIV-ASSIST tool is to enter the information given into the input screen, using these check boxes and dropdown menus.

In this case, the user would indicate that the HIV-1 RNA is considered very high—>500,000 copies/mL. The CD4+ cell count is >200 cells/mm3. In this case, the HLA-B5701 status is unknown, and there were no tropism assays conducted. If there had been any comorbidities, comedications, or prior treatment history, that could be entered as well, but in this case example, all of those are left blank.

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Tailoring to Local ARV Availability: Check Boxes to Exclude Any Drugs Unavailable in Your Region

An important note is that you have the ability to customize HIV-ASSIST’s outputs based on available drugs in your region.1

The tool has the ability to consider all possible combinations of ARVs. But because not all drugs are universally available, it is important to have the ability to select or unselect those that are not commonly available in one’s specific region.1

There are a number of drugs that excluded by default. For example, the combination of tenofovir, lamivudine, and dolutegravir (TLD) is not available in the United States but is a commonly used agent that is recommended and available across many Asia-Pacific regions. So, users have the ability to toggle whether to include this drug in HIV-ASSIST’s outputs.1-3

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Tailor to Availability and Preferences

Other drugs excluded by default include older drugs such as stavudine and didanosine, and the older protease inhibitors (PIs). Tenofovir disoproxil fumarate (TDF) and TDF-containing combinations are also excluded by default.1

Regardless, these drugs and other combination products can be selected or unselected based on your local preferences or drug availability.1

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HIV-ASSIST Decision Support Is Guideline-Based

After you input the viral and patient factors and tailor the drugs to be assessed based on local availability, HIV-ASSIST will provide a list of ranked ART regimens, as shown on this slide. The top options are shown in green, and you can see that there are a number of regimens considered preferred, or even ideal, for this patient.1

HIV-ASSIST is calibrated to provide outputs and recommendations that reflect national and international guidelines. In our case scenario, most current guidelines indicate a preference for 2 NRTIs with an integrase inhibitor as first-line therapy for treatment-naive individuals. Those regimens are shown in the HIV-ASSIST output.1

To illustrate how HIV-ASSIST ranks ART regimens based on available guidelines, the bottom half of this slide depicts recommended ART regimens for initial therapy, according to international guidelines from the US Department of Human and Health Services (DHHS), WHO, and the National AIDS Control Organization of India.2-4

The patient in our case scenario has a HIV-1 RNA >500,000 copies/mL. Thus, per DHHS guidelines, dolutegravir (DTG)/lamivudine (3TC), a 2-drug regimen, was excluded from the recommendations. This demonstrates how HIV-ASSIST attempts to apply all known applicable guidelines to each individual case. Based on the available evidence, DTG/3TC is not indicated for individuals with very high HIV-1 RNA and therefore was excluded from this top set of regimens shown on this screen.1,2

Similarly, this patient’s HLA-B5701 status is not available, so the system has automatically excluded DTG with abacavir and 3TC, in accordance with the DHHS guidelines. This shows how the various nuances of these guidelines are integrated into the decision-making algorithms used by HIV-ASSIST.1,2

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HIV-ASSIST: Updated Resources in One Place

Overall, HIV-ASSIST is a novel method of clinical guideline delivery that allows healthcare professionals (HCPs) to apply the different aspects of all available guidelines to individualized scenarios. The tool evaluates every possible ART option and ranks them in a manner that is easy for HCPs to use.1

The tool also seeks to be a consolidated provider resource. Embedded into the tool is clinical trial data and information from the Stanford HIV drug resistance database and the University of Liverpool HIV Drug Interaction checker.1

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HIV-ASSIST Output: Clicking on Any Regimen Opens Relevant Education Sheets

To access additional educational materials, click on any of the drug regimens seen on the output screen.1

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HIV-ASSIST Output: Clicking on Any Regimen Opens Relevant Education Sheets

The first thing shown after clicking on one of these regimens is an educational summary. This includes an overview of regimens that include 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 integrase inhibitor.1

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HIV-ASSIST Output: Education Sheets Include Summaries of Evidence From the Primary Literature

Scrolling further down on that same page, you will find summaries of evidence from clinical trials in table format. This enables users to easily find primary literature supporting the usage of particular ARV regimens for their patients.1

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