5. HIV, Jimenez, Part 2

OBJECTIVES: understand the principles of managing HIV in treatment-experienced patients

• Review medical and social history

  • ARV treatment history

  • Results of previous resistance tests

  • HIV RNA, CD4 changes over time

  • Medical conditions: Co-morbidities, mental health disorders, HIV-related events

  • Adherence, tolerability, concomitant medications, drug–drug or drug–food interactions

  • Determine what factors may be barriers (i.e. social, economic, psychological)

• Perform resistance testing

OBJECTIVES: compare and contrast the pharmacologic characteristics of the antiretroviral agents

OBJECTIVES: recognize key concepts of antiretroviral drug resistance

OBJECTIVES: select a viable regimen in a patient experiencing treatment failure based on relevant clinical factors

2 fully active agents with one that has a high genetic barrier

if not, give 3 active agents

OBJECTIVES: describe the appropriate action for post-exposure prophylaxis for the prevention of HIV

emtricitabine/TDF + raltegravir BID

or

emtricitabine/TDF + dolutegravir daily

only if > 72 hours

Types of HIV exposure requiring post exposure prophylaxis

• percutaneous (needlestick)

• contact of mucus membrane or on-intact skin

• sexual

How soon should someone start post exposure prophylaxis?

ASAP and within 3 days

OBJECTIVES: recommend the appropriate regimen for pre-exposure prophylaxis when indicated, including necessary lab testing

indicated for

• ppl w HIV positive partner

• bacterial STI in the past 6 months

• inconsistent or no use of condom

• HIV positive injecting partner or sharing injection equipment

• negative HIV test

Medications for Pre Exposure Prophylaxis

OBJECTIVES: understand the principles of managing HIV in pregnancy

Dolutegravir is the way to go (esp bc w morning sickness, a once a day drug is the way to go)

recommended to ALL pregnant women with HIV ASAP

Intrapartum management

IV zidovudine:

• NOT for <50 copies

• recommended for >1000 copies

C-section at 28 weeks if

• 1000 copies near time of delivery

Neonatal Care

• breast feeding is supported

Maraviroc

Ibalizumab

Fostemasvir

Lenacapravir

Virologic response

attaining and maintaining HIV RNA <200

Virologic failure

inability to achieve and maintain HIV RNA <200

Virologic blip

as isolated HIV RNA level (>50 copies) that is followed by a return to virologic suppression

Low-level viremia

consecutive or consistent detectable HIV RNA