Dr. Spencer mixed up Noon Report today and educated the VA residents about HIV, anti-retrovirals, and special health care maintenance needed for patients with HIV.
Screening for HIV is indicated at least once for all patients between ages 13 -65 (CDC and USPTF) and after any high risk behavior or exposure. For HIV screening, we start with the 4th generation Ag/Ab Immunoassay which becomes positive much more quickly than the traditional western blot.
Don’t forget that Antigen/Antibody positivity takes~17 days. If high clinical suspicion for acute HIV, get a HIV viral load/PCR.
If a patient comes in with a positive home POC test you should still start the algorithm at the beginning with Ag/Ab immunoassay.
Tenofovir: side effects include renal dysfunction, osteoporosis
Abacavir: requires HLAB5701 testing due to risk of hypersensitivity reaction
Emtricitabine: side effects include dyslipidemia
induces CYP 2A which can interact with Keppra
Efavirenz: neuropsychiatric side effects
Rilpivirine: cannot be started when VL >100K; cannot use with PPI (requires acid for absorption)
Protease Inhibitors and Boosters (ritonavir, darunavir, atazanavir)
can increase statin levels and cause myopathy and rhabdomyolysis
inihibit steroid metabolism which can cause iatrogenic Cushing’s
side effects include dyslipidemia
Integrase inhibitors (raltegravir, dolutegravir)
New data questioning potential for neural tube defects during pregnancy
Interacts with divalent cations (cannot take with Mg, Ca supplements)
Maraviroc: requires tropism testing
Thanks Dr. Spencer!
•Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–1533. doi:10.1016/S0140-6736(13)61809-7
•Branson BM et.al Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. 2006. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm