HIV part 2

Jimenez

When is testing ideal in a patient

if the patient is still taking ART or < 4 weeks from ART discontinuation

>500 copies need to be present to test

Proviral HIV ENA Genotype Testing

+when is it used

option in patients with undetectable virus (<500-1000 copies)

less sensitive than cumulative RNA based genotype tests

Ibalizumab

+indication, dosing

used when multi drug resistance

approved for heavily Tx-experienced patients

IV q2 weeks

Fostemsavir indication

used in multi drug resistance

for heavily Tx-experienced patients

Maraviroc

+class, use, testing required

CCR5 antagonist

used in multidrug ressistance

Requires tropism assay to determine R5 virus

• repeat test if previous one is old

Lenecapavir

+class, administration, indication

capsid inhibitor

administered SubQ q 6 months

used in multi drug resistance

for heavily Tx-experienced patients

Post Exposure Prophylaxis (PEP)

+def.,

preventing exposure following exposure to a pathogen (ex: getting stuck by a needle)

Risk Factors for HIV Seroconversion

+fluids that are definitely infectious, fluids that are not infectious, rank: receptive/insertive anal, penile-vaginal, oral

definitely: blood, tissue

not infectious (unless visibly bloody): sweat, tears, nasal secretions, saliva, sputum, vomitus, urine, and feces

receptive higher than insertive risk

receptive anal>insertive anal> receptive penile-vaginal> insertive penile-vaginal>receptive/insertive oral (very low)

Increased risk for seroconversion

viral load

late-stage HIV infection

Hollow bore vs. solid bore

STIs

PEP considerations

+timing, history, labs, duration

Timing

• start PEP ASAP (less effective 72 hours after exposure)

Obtain history of potential exposure event

• occupational vs non occupational

• HIV and HBV status of exposure of ex

Conduct labortotry testing

Duration : 28 day PEP course

Preferred Treatment for occupational Exposure

Emtricitabine/TDF + raltegravir BID OR dolutegravir

reevaluate within 72 hours

if source id HIV negative PEP can be discontinued

Pre-exposure prophylaxis (PrEP)

+def., approved agents + indications for each

ART prescribed to reduce risk of HIV aquisition

Emtricitabine/TDF

• Not approved for people who inject drugs but reccomended

Emtricitabine/ T F

• Not recommended for Heterosexual women and people who inject drugs AS PrEP

Cabotegravir inj.

• not recommended for people who inject drugs AS PrEP

Preferred ARV drugs for antepartum care

primary: dolutegravir

emtricitabine or lamivudine/ TDF or TAF

not ideal bc you wont want to wait for test: abacavir/lamivudine

Use only if CAB-La exposure: darunavir +ritonavir BID

drugs with insufficient Datta for HIV pregnancy

doravirne, abotegravir/rilpivirne, cobicistat containign formulations

Risk HIV RNA level close to delivery

>1000 copies

• schedule C-section

• use IV zidovudine