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Content Update

January 25, 2022

2021 Clinical Guideline Updates for Managing Clostridioides difficile Infection in Adults: In 2021, the American College of Gastroenterology (ACG) and the Infectious Disease Society of America (IDSA) in collaboration with the Society of Healthcare Epidemiology of America (SHEA) each published clinical practice guideline updates for the prevention, diagnosis, and treatment of Clostridioides difficile in adults.

Content Update

August 5, 2021

Cabotegravir/Rilpivirine Approved for Treatment of Stable HIV Patients as Extended-Release Antiretroviral Regimen: In January 2021, the U.S. Food and Drug Administration (FDA) approved cabotegravir (Vocabria) oral tablets and cabotegravir/rilpivirine (Cabenuva) extended-release (ER) intramuscular (IM) injection as a combination antiretroviral therapy (cART) for patients who are virologically suppressed on oral therapy. Multicenter randomized controlled trials demonstrated non-inferiority of cabotegravir + rilpivirine (CAB + RPV ER) (28-day oral lead-in phase followed by once-monthly IM injections) for maintaining HIV viral suppression vs standard oral cART. This novel dosing regimen offers a promising strategy to increase patient satisfaction and medication adherence. Additionally, preliminary 48-week data from the global phase 3b ATLAS-2M trial demonstrated non-inferiority of CAB + RPV ER given at 8-week intervals compared to administration every 4 weeks. This regimen may further improve patient adherence.

Content Update

April 4, 2019

New guideline recommendations regarding prophylaxis in Pneumocystis pneumonia (PCP) and Mycobacterium avium complex (MAC) disease: The U.S. Department of Health and Human Services (DHHS) Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV were updated in early 2019. Among the updates included in this guideline issue were recommendations for when to discontinue prophylaxis (both primary and secondary) for PCP and the decision to initiate primary prophylaxis for MAC. Guidelines now support the discontinuation of PCP prophylaxis (primary or secondary) in patients with an undetectable viral load and a CD4 count between 100 – 200 cells/mm3 for 3-6 months (BII rating). Additionally, the panel no longer recommends primary prophylaxis for MAC in patients able to initiate antiretroviral therapy (ART) immediately regardless of CD4 cell count (AII rating). Healthcare providers should carefully interpret updated guidelines and integrate into clinical practice.



Upon completion of the chapter, the reader will be able to:

  1. Explain the routes of transmission for human immunodeficiency virus (HIV) and its natural disease progression.

  2. Identify typical and atypical signs and symptoms of acute and chronic HIV infection.

  3. Identify the desired therapeutic outcomes for patients living with HIV.

  4. Recommend appropriate first-line pharmacotherapy interventions for patients with HIV infection.

  5. Recommend appropriate second-line pharmacotherapy interventions for patients with HIV infection.

  6. Describe the components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for HIV infection.

  7. Educate patients about the disease state, appropriate lifestyle modifications, and drug therapy required for effective treatment.


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