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HIV/AIDS and ART

Kathryn Snyder and Quinton Taylor

Background

  • 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

  • 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

    • Lab evaluation:

      • HIV viral load, genotype, and resistance testing

      • T cell subsets (CD4 Count), CBC with differential, CMP, UA

      • HLA*B5701 testing before using abacavir containing regimen

      • QuantiFERON Gold

      • Pregnancy testing

      • Viral hepatitis serologies

      • Toxoplasma serologies

      • Other STI screening (Syphilis, Gonorrhea/Chlamydia)

  • 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

  • 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

  • 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