HIV/AIDS and ART¶
Kathryn Snyder and Quinton Taylor
Background¶
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Why is ART important?
- Clear morbidity and mortality benefits across all CD4 counts
- Decreases subsequent infections (both common and opportunistic)
- Decreased HIV related comorbid conditions, viral reservoirs, and transmission
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New HIV Diagnosis
- ID consult if patient is not on Rogers ID service (important for initiation, follow up [CCC], social work assistance)
- ART is indicated for all HIV+ patients, regardless of CD4; however, starting ART requires appropriate outpatient follow up
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Lab evaluation:
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HIV viral load, genotype, and resistance testing
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T cell subsets (CD4 Count), CBC with differential, CMP, UA
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HLA*B5701 testing before using abacavir containing regimen
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QuantiFERON Gold
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Pregnancy testing
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Viral hepatitis serologies
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Toxoplasma serologies
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Other STI screening (Syphilis, Gonorrhea/Chlamydia)
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Timing of ART initiation
- Factors affecting timing of initiation
- Drug toxicity and interactions, risks for resistance, adherence barriers
- Treatment of opportunistic infections may delay initiation of ART given associated risk of immune reconstitution inflammatory syndrome (IRIS)
- Delay ART for several weeks after initiation of therapy for cryptococcal meningitis, tuberculosis, and CMV retinitis
- Factors affecting timing of initiation
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ART plan for overnight admits: okay to continue home ART, special consideration for:
- Patients with hepatic or renal dysfunction may need dose adjustment
- Interactions with other newly initiated medications
- If there is concern for non-adherence, can hold morning dose
- Combination pills may need to be ordered as separate components
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Common key regimens for initiation
- Most regimens consist of an NRTI backbone (2 agents) plus a 3rd agent
- Some dual therapy regimens (such as Dovato@) are non-inferior to standard 3-drug therapy
- Many patients are started on combination pill regimens, including Integrase Inhibitor based regimens: Biktarvy®, Dovato®, Triumeq®, Genvoya®, dolutegravir + Descovy®
Last update:
2022-06-22 02:01:49