Welcome to Short Scoops in HIV

In this asynchronous online activity, we will be exploring timely clinical topics related to caring for people living with HIV.


HIV Prevention: Navigating Real World Challenges
**No Longer Available for Credit**

Ron is a 19-year-old male who visited a minute clinic three days ago with an acute onset of fever, fatigue, myalgia and headache.  His past medical history is consistent with an episode of primary syphilis and rectal gonorrhea in the past year; both were successfully treated.  He is sexually active with both male and female partners and does not consistently use barrier precautions.  He was on PrEP more than a year ago, but did not routinely follow up for his appointments and his provider stopped renewing his prescription.

His rapid HIV antibody test and influenza test were negative at the minute clinic.  He was then referred to your clinic and expresses a motivation to reinitiate PrEP?

Questions:

  1. Would you initiate PrEP for the patient at this time?  Why or why not?
  2. What other things would you do or consider at this visit?


Transfer of HIV Care – What Do You Need to Consider?
**No Longer Available for Credit**

   

Deborah, a 31-year-old female, has recently moved to your area and she schedules an appointment to establish care.  She has no additional medical history.  She takes a multivitamin daily.  She was diagnosed with HIV at her OB/GYN’s office 10 years ago by routine screening.  She was started on coformulated emtricitabine/tenofovir disoproxil fumarate/efavirenz (Sustiva) at that time by her HIV provider and she has been on it since her diagnosis and she has no tolerability issues. She is currently asymptomatic.

Data:

  • BP: 120/70 mmHg
  • CD4 count: 700 cells/mm3
  • HIV RNA by PCR: <20 copies/mL
  • Hepatitis A and B: immune
  • Hepatitis C antibody: negative

Questions for Discussion:

  1. What additional information would be important for you to know about Deborah as she transfers into your care?
  2. Would you recommend updating Deborah’s antiretroviral therapy to an integrase inhibitor based regimen?  Why or why not?
  3. At what point do you approach changing a patient’s regimen who is new to your practice and you are still developing a trusting relationship?

Welcome to Short Scoops in HIV

In this asynchronous online activity, we will be exploring timely clinical topics related to caring for people living with HIV.



Weight Gain and Integrase Inhibitors
**No Longer Available for Credit**

Consider the Following Case:

Amanda, a 46-year-old African American female, presents to your office for a follow-up visit.  She was diagnosed with HIV 10 years ago and has been doing well on a regimen of TDF/FTC/EFV with consistent viral suppression. In the past, she has declined a switch off efavirenz (EFV). She presents today and is ready to discuss a change. After a discussion, you both decide to change her regimen to TAF/FTC and DTG. She switches and has no tolerability issues.

Amanda returns in 1 month for a follow-up visit and complains that her clothes are tight and she has noticed a 10-pound weight gain since she started taking the regimen.

Data:

  • BP 128/80 mmHg
  • CD4 count-800 cells/mm3
  • HIV viral load-< 20 copies/mL

Questions for Discussion:

  1. Amanda asks if you think the new regimen is causing her weight gain. How do you counsel her?
  2. Would you switch her regimen? If so, to what?

Welcome to Short Scoops in HIV

In this asynchronous online activity, we will be exploring timely clinical topics related to caring for people living with HIV.


Rapid Start in the Naïve Patient
**No Longer Available for Credit**


Consider the Following Case:
Martin, a 34-year-old African American male, presents after being diagnosed with HIV.  He has no past medical history.  He takes a multivitamin daily and for occasion heartburn he takes over the counter antacids including Tums and Rolaids. He was diagnosed at his primary care provider’s office 2 days prior and he was sent to you for evaluation/treatment. The testing was done as part of routine primary care. His last HIV test was 2 years ago and it was negative.  He is currently asymptomatic.

Data:

  • BP: 110/70 mmHg
  • HIV antigen/antibody screening test: reactive
  • HIV antibody-reactive
  • Labs drawn and pending including HIV-1 genotype
  • Pt is ready to start treatment

Questions for Discussion:

  1. Would you start him on treatment today prior to his lab work coming back?
  2. What treatment option would you start and why?