Question 9 - HIV in Older Adults Question Bank

HIV Clinical Care Question Bank

HIV in Older AdultsQuestion 9/10

A 68-year-old man has just been diagnosed with HIV, and he has not yet started on antiretroviral therapy.

Which one of the following statements is TRUE regarding antiretroviral therapy for older individuals with HIV?

Dolutegravir should not be used in persons older than 50 years of age

Ritonavir is contraindicated in older individuals with HIV

Abacavir is not recommended in individuals with HIV older than age 50 due to unacceptably high rates of abacavir hypersensitivity syndrome

The recommended treatment regimens are the same as in younger persons

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Question Last Updated
July 17th, 2026

Table 1. Recommended Initial Regimens for Most People with HIV: Adult and Adolescent ARV Guidelines

Panel’s Recommendation
Recommended regimens are those with demonstrated durable virologic efficacy, favorable tolerability and toxicity profiles, and ease of use. Choice of antiretroviral therapy during pregnancy should be guided by recommendations from the Perinatal Guidelines.
For people who do NOT have a history of long-acting cabotegravir use as HIV preexposure prophylaxis (PrEP), the following regimens are recommended:
Bictegravir-tenofovir alafenamide-emtricitabine (AI) Dolutegravir plus (tenofovir alafenamide or tenofovir DF)^a plus (emtricitabine or lamivudine) (AI) Dolutegravir-lamivudine (AI), except for individuals with HIV RNA >500,000 copies/mL, hepatitis B virus (HBV) coinfection, or when antiretroviral therapy is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available
For people with HIV and a history of using long-acting cabotegravir as HIV PrEP, integrase genotypic drug resistance testing should be done before the start of antiretroviral therapy. If treatment is begun prior to the results of genotypic testing, the following regimen is recommended:
Darunavir (boosted with cobicistat or ritonavir) plus (tenofovir alafenamide or tenofovir DF)^a plus (emtricitabine or lamivudine)—pending the results of the genotype test (AIII).
^aTenofovir alafenamide and tenofovir DF are two forms of tenofovir approved by the FDA. Tenofovir alafenamide has fewer bone and kidney toxicities than tenofovir DF, whereas tenofovir DF is associated with lower lipid levels. Safety, cost, and access are among the factors to consider when choosing between these drugs. Rating of Recommendations: A = Strong; B = Moderate; C = Weak Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies, or regimen comparisons from randomized switch studies; III = Expert opinion

Source:

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. What to Start. Initial Combination Antiretroviral Regimens for People With HIV. September 12, 2024. [HIV.gov]

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