February 2026 TTU: Updated Guidelines: Initial ART and HIV-2, plus new episodes of Viremic--Cases in HIV

Topics, Trends & Updates

February 2026

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Updated: Selecting an Initial ART Regimen

The Selecting an Initial ART Regimen guideline was developed for primary care providers and other practitioners who are initiating therapy in nonpregnant, ART-naive adults with HIV.

Updates by author Dr. Antonio E. Urbina and the Medical Care Criteria Committee (MCCC) include:

Available Antiretroviral Medications section: In Table 1, for lamivudine/dolutegravir, the comment “Do not initiate in patients with baseline HIV RNA levels >500,000 copies/mL until additional study data are available” has been removed.
General Principles in Choosing an Initial ART Regimen section: Updated text and references added.

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Updated: Diagnosis and Management of HIV-2 in Adults

The Diagnosis and Management of HIV-2 in Adults guideline was developed for primary care providers and other clinicians who may diagnose and treat adults with HIV-2 infection.

Updates by author Dr. Sanjiv S. Shah and the MCCC include:

Global: Updated discussion and references throughout guideline
Treatment of HIV-2 section:
Updated preferred and alternative ART regimens for initial treatment of nonpregnant adults with HIV-2 (Tables 1 and 2)
Added Table 3: Other Initial ART Regimen Not Included as Preferred or Alternative for Nonpregnant Adults with HIV-2
Management of HIV-2 in Pregnancy section:
Added recommendation: In selecting an ART regimen for a pregnant individual with HIV-2, clinicians should not include EVG/COBI and DRV/COBI, because of the potential for lower levels of drug exposure during the third trimester (A*)
Updated Table 4: ART Regimens for Initial Treatment of Pregnant Adults With HIV-2
PrEP and PEP for HIV-2 section: Added recommendation: Clinicians should recommend TAF/FTC/BIC as PEP after HIV-2 exposure. (A2†)

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Viremic—Cases in HIV Podcast

Join Hosts Eileen Scully and Christopher Hoffmann as they present cases, explore quandaries in adult HIV care, and discuss key evidence and guidelines that inform clinical decision-making.

New Episodes

Case 14. “AIDS Is Not My Worst Problem”: Caring for Women with HIV: The case of a 28-year-old diagnosed with HIV when she became pregnant prompts Eileen and guest Dr. Jean Anderson to explore many of the challenges of HIV care in pregnancy: managing a new diagnosis, disclosure, stigma, partner involvement, antiretroviral therapy, perinatal transmission prevention, breastfeeding, harm reduction, and postpartum care. Their wide-ranging discussion opens with Jean’s perspective on care of women with HIV, which is informed by 40 years of ground-breaking work in the field. Listen Now

Case 15. A Pain in the Butt: Anal Cancer Screening and Prevention: Chris presents the case of a 42-year-old gay man at high risk of anal cancer to guest Dr. Bruce Hirsch, and they work through the best course for screening and prevention of a disease with high rates of morbidity and mortality that disproportionately affects people with HIV. Listen as Chris and Bruce talk about who to vaccinate and when, who and when to screen, and what screening entails, while acknowledging the difficulties. Listen Now

Coming Soon

Case 16. Mpox After the Outbreak: A 33-year-old man with HIV presents with a flu-like syndrome and a disseminated vesicular rash after sexual contact with a new partner. Differential diagnosis includes mpox, syphilis, other STIs, HSV, and disseminated VZV. Listen as Eileen and her guest Dr. Shauna Gunaratne work through the mpox diagnosis and discuss the 2022 mpox outbreak, along with evidence-based recommendations for testing, treatment, and prevention. Listen February 17

Case 17. Trans Lives Matter: Affirmative HIV Care: Guest Dr. Asa Radix, from Callen-Lorde and the Clinical Guidelines Program (CGP), and Dr. Chris Hoffmann, from Johns Hopkins and the CGP, review the case of a 32-year-old transgender woman who was diagnosed with HIV, with testing performed while she was receiving gender-affirming care. With a viral load of 82,000 and CD4 count of 365, she had no resistance mutations and no other known major medical conditions. Asa walks Chris through the approach to ART and gender-affirming HIV and primary care for this patient. Listen March 3

We’re open to suggestions! To submit a clinical topic for a Viremic case discussion, email us at viremicpodcast@jh.edu.

Conversations With CEI Podcast

Two New Treatments for Gonorrhea; one is available now! In this episode of the Conversations with CEI, infectious disease specialist Dr. Steven Fine delves into groundbreaking advancements in the treatment of urogenital gonorrhea. The episode highlights the FDA's December 2025 approval of two innovative oral therapies that mark a significant step forward in combating this prevalent sexually transmitted infection.

Dr. Fine discusses the first of these treatments, Zoliflodacin (Nuzolvence), a novel medication specifically developed for urogenital gonorrhea. Administered as a single oral dose, it offers patients a convenient and effective option. The second treatment, Gepotidacin (Blujepa), is a versatile drug initially approved in March 2025 for urinary tract infections (UTIs). Now, it has been authorized for urogenital gonorrhea treatment, requiring two oral doses for optimal efficacy.

Throughout the episode, Dr. Fine provides insights into the clinical trials, mechanisms of action, and potential impact of these therapies on public health. He also emphasizes the importance of addressing antibiotic resistance in gonorrhea and how these new treatments may help mitigate this growing concern. Listen Now

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